Recurrent Hemorrhagic Stroke in a Patient with Neurosarcoidosis

A 45-year-old Japanese woman had sudden-onset subarachnoid hemorrhage and subsequently developed recurrent intracerebral hemorrhages and multiple infarctions in the left and right cerebral hemispheres, respectively. Angiotensin-converting enzyme (ACE) levels in the cerebrospinal fluid (CSF) were elevated, and a pathological examination of brain biopsy samples demonstrated multinucleated giant cell infiltration and epithelial granuloma formation in thickened pial vessel walls. After treatment with intravascular methylprednisolone 1,000 mg for 3 days, followed by oral prednisolone, she had no recurrence of cerebrovascular events. Although systemic involvement was lacking, isolated neurosarcoidosis was diagnosed based on increased ACE levels in the CSF and pathological findings.