Neurosarcoidosis - the Role of Magnetic Resonance Imaging in Diagnostics

Sarcoidosis is a multisystem granulomatous disease of unknown etiology, characterized by presence of granulomas in affected tissues with variety in clinical presentations and presents a differential diagnostic and therapeutic dilemma. Clinical presentation of neurosarcoidosis is very variable. Diagnosis is based on clinical and radiological criteria and histological findings of disseminated non-necrotic granuloma followed by negative cultures for bacteria and fungi. MRI plays a key role in detection of lesions located in the brain parenchyma.

The aim of this article was to present case of a 36-year-old male patient, who came to doctor with symptoms of fever, dry cough with whitish sputum, lymphadenopathy of neck region and neurological disturbances in form of headaches and vision problems.

Patient underwent on pulmonary examination and results indicated presence of sarcoidosis. CT examination was performed (SIEMENS Somatom Definition AS, Erlangen, Germany), which confirmed presence of mediastinal and hilar lymphadenopathy. Ultrasound (US) examination of a neck region was also performed showed significantly enlarged and morphology altered lymph nodes. After biopsy of several neck lymph nodes, histopathological was proven diagnosis of sarcoidosis. Due to neurological disturbances in form of headaches and vision problems patient was examined by an ophthalmologist, neurologist and endocrinologist. Hormonal analysis showed an increase of prolactin and that raised suspicion for neurosarcoidosis. In further diagnostic evaluation it was indicated MRI examination of the brain with focus on sellar region.

Contrast-enhanced MRI is the modality of choice for investigating suspected neurosarcoidosis. The versatility of MR recording and the amount of diagnostic informations obtained from MRI examination is huge. Comparison of MRI sequences obtained, facilitate interpretation of these findings. Obtained MRI information and available literature, correlating with other diagnostic modalities (ultrasound and CT) facilitate understanding of the specific pathology.