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Neurosarcoidosis: A Case Report.

Margarida L Nascimento¹, Rui Casanova², Filipa Ramalho Rocha¹

¹Internal Medicine Department, Hospital Da Luz Lisboa, Lisbon, PRT.

|June 2, 2022

Summary

This summary is machine-generated.

Sarcoidosis, a rare multi-organ disease, can affect the nervous system. This case highlights the diagnostic challenges of neurosarcoidosis presenting with hearing loss and facial palsy.

Keywords:

extrapulmonary sarcoidosis granulomatous diseases neurosarcoidosis noncaseating granulomas sarcoidosis

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Area of Science:

Neurology
Immunology
Pathology

Background:

Sarcoidosis is a systemic granulomatous disease of unknown origin.
Neurological involvement, termed neurosarcoidosis, is infrequent but significant.
Cranial nerve palsies, particularly of the VII and VIII nerves, are key indicators of neurosarcoidosis.

Observation:

A 54-year-old woman presented with constitutional symptoms, bilateral hearing loss, and later developed uveitis and facial palsy.
Imaging revealed mediastinal lymphadenopathy, and PET scans showed hypercaptation.
Cranial nerve involvement was confirmed by MRI showing inflammation of the cochlea, geniculate ganglion, and vestibulocochlear bundles.

Findings:

Cerebrospinal fluid analysis indicated aseptic meningitis.
Histopathological examination of mediastinal lymph nodes confirmed noncaseating granulomas, establishing the diagnosis of sarcoidosis.
Treatment with high-dose steroids resulted in significant clinical improvement.

Implications:

This case underscores the diagnostic complexities of neurosarcoidosis, often a diagnosis of exclusion.
Early recognition and appropriate treatment are crucial for managing the unpredictable clinical course and prognosis of neurological sarcoidosis.
Highlights the importance of considering neurosarcoidosis in patients with unexplained cranial neuropathies and systemic symptoms.