Neurosarcoidosis Presenting With Confusion and Speech Alteration

Area of Science:

• Neurology
• Immunology
• Pathology

Background:

• Sarcoidosis is a multisystem inflammatory disease.
• Neurosarcoidosis (NS) is a rare but serious manifestation.
• Early diagnosis of NS is crucial for effective management.

Observation:

• A 65-year-old male presented with acute confusion, speech alteration, and facial droop.
• He had a history of Ramsay Hunt syndrome and Lyme infection.
• Months of fatigue, ataxia, headaches, neuropathy, and bladder issues preceded the acute episode.

Findings:

• Chest CT revealed mediastinal lymphadenopathy; lymph node biopsy showed non-necrotizing granulomas.
• Brain MRI indicated pituitary enlargement, trigeminal nerve enhancement, and leptomeningeal enhancement.
• Cerebrospinal fluid analysis was consistent with aseptic meningitis, leading to a probable NS diagnosis.

Implications:

• This case underscores the diagnostic difficulty of NS due to its diverse clinical presentations.
• Vague chronic neurological symptoms followed by acute neurological decline can mask NS.
• Prompt recognition and treatment, including corticosteroids, are vital for improving outcomes in NS.