Intracranial sarcoidosis with optic tract and temporal lobe involvement

Intracranial sarcoidosis was diagnosed in a 23-year-old man when he developed a markedly incongruous right homonymous hemianopic visual field defect. The diagnosis was substantiated by radiologic evidence of bilateral hilar and paratracheal adenopathy, typical of pulmonary sarcoidosis. Subsequently, computed axial tomography indicated a large intracranial lesion in the suprasellar cistern with extension into the left temporal lobe along the optic tract. A mediastinal biopsy of the lymph nodes was positive for sarcoid. Intensive corticosteroid therapy resulted in restoration of vision, marked improvement of the visual field defect, decrease in the pulmonary hilar adenopathy, and almost complete resolution of the left temporal lobe lesion.