Diagnostic challenge in isolated Neurosarcoidosis: A case report

Neuro-sarcoidosis is one of the uncommon manifestations of sarcoidosis that presents with diagnostic difficulties, particularly when the patient does not show any signs of extra-neural disease. We report an 18-year-old female with an initial manifestation of neck pain, vomiting, seizures and cranial nerves palsies. The first MRI showed the T2 Flair hyperintensity, cortical T1 hyperintensity, nodular leptomeningeal enhancement and small focus of restricted diffusion, which is an isolated finding in the neuro-sarcoidosis. Peripheral nerve biopsy showed the presence of a non-caseating granuloma. This case brings out the challenges of diagnosing neuro-sarcoidosis due to the diverse forms of neurological manifestation of the disease and its mimicry of other diseases such as multiple sclerosis. Sarcoidosis manifestations do not have strong systematic features, and hence, requires sophisticated clinical, radiological and CSF analysis for a provisional diagnosis. This case points to the diagnostic significance of neuro-sarcoidosis in patients developing the neurological manifestations, as well as the necessity for the multiple-disciplinary approach to the management of the disease.