Neurosarcoidosis mimicking multiple meningiomas: illustrative case

Area of Science:

• Neurology
• Neurosurgery
• Pathology

Background:

• Neurosarcoidosis is a rare condition presenting with diverse and nonspecific neurological symptoms.
• It is often misdiagnosed due to its rarity and varied clinical manifestations, posing diagnostic challenges.
• Distinguishing neurosarcoidosis from more common intracranial extra-axial lesions like meningioma is crucial for appropriate management.

Purpose of the Study:

• To report a rare case of neurosarcoidosis presenting as multiple intracranial extra-axial lesions.
• To review the clinical and surgical features of neurosarcoidosis.
• To highlight diagnostic challenges and potential aids in differentiating neurosarcoidosis from meningioma.

Main Methods:

• A case study of a 64-year-old man with blurred vision.
• Diagnostic workup included Gadolinium-enhanced MRI and intraoperative frozen-section analysis.
• Postoperative histopathological evaluation confirmed neurosarcoidosis, followed by corticosteroid therapy.

Main Results:

• Initial MRI revealed multiple, uniformly enhancing, extra-axial lesions, leading to suspicion of meningioma.
• Postoperative histopathology confirmed noncaseating granulomatous inflammation, diagnosing neurosarcoidosis.
• Corticosteroid therapy resulted in significant lesion reduction on follow-up MRI, with gradual improvement of transient oculomotor nerve palsy.

Conclusions:

• Pre- and intraoperative diagnosis of neurosarcoidosis is challenging but may be aided by characteristic T2-weighted imaging and intraoperative findings.
• Considering the potential for steroid-responsive dural inflammation in surgical planning can help minimize invasiveness.
• Accurate diagnosis and timely steroid treatment are essential for managing neurosarcoidosis and preventing complications.