Central nervous system sarcoidosis

Sarcoidosis may involve the central nervous system (CNS) in approximately 5% of cases. Three levels of neurological involvement are possible and include cranial nerve abnormalities, peripheral neuropathies, and lesions of the brain, spinal cord, and meninges. In addition to abnormal neurological findings, psychiatric presentations of CNS sarcoidosis include symptoms of delirium, dementia, depression, personality changes, and psychosis. The diagnosis usually rests on neurological, psychiatry, and cerebrospinal fluid (CSF) abnormalities with a history of sarcoidosis in other organ systems. The CSF, however, may be normal in as many as 30% of cases. The complexities of the illness and the difficulties that may be encountered in making the diagnosis are illustrated with a case of suspected CNS sarcoidosis that presented with delirium and choreoathetosis. The use of steroids as the mainstay of treatment is also discussed.