Sarcoid encephalopathy with diffuse inflammation and focal hydrocephalus shown by sequential CT

Area of Science:

• Neurology
• Radiology
• Immunology

Background:

• Cerebral sarcoidosis is a rare manifestation of systemic sarcoidosis.
• Encephalopathies of obscure origin warrant thorough investigation.
• Noninvasive imaging like CT aids in serial monitoring of neurological conditions.

Observation:

• A patient with seizures and organic mental syndrome underwent sequential computerized tomography (CT).
• The patient was diagnosed with cerebral sarcoidosis based on noncaseating granulomas in three organ systems.
• Neurological examination revealed no cranial nerve palsies or hypothalamic dysfunction, and disease was not widespread.

Findings:

• Unusual neuroradiologic findings included focal and asymmetric hydrocephalus, mass effect, ependymitis, diffuse blood-brain barrier breakdown, and periventricular white matter destruction.
• These specific neuroradiologic findings have not been previously reported together in sarcoidosis.
• The case highlights a distinct pattern of central nervous system involvement in sarcoidosis.

Implications:

• Serial CT investigations can reveal subtle or evolving changes in encephalopathies.
• The described neuroradiologic sequence should prompt a comprehensive search for subclinical systemic sarcoidosis.
• This case expands the understanding of neuroimaging manifestations in cerebral sarcoidosis.