PARANOID PSYCHOSIS DUE TO NEUROSARCOIDOSIS

We present two patients with known sarcoidosis who developed neurosarc oidosis manifested by paranoid psychosis and clinical diabetes insipid us with hypernatremia. Both had gadolinium enhanced magnetic resonance imaging which demonstrated leptomeningeal and hypothalamic enhancemen t. Both had elevated protein and a lymphocytosis in their cerebrospina l fluid, which improved after corticosteroid therapy. The patients imp roved clinically with this therapy as well. We suggest that new onset psychosis in a sarcoid patient, particularly with symptoms of hypothal amic/pituitary involvement, should be evaluated for neurosarcoidosis w ith an MRI and CSF examination. If the results are consistent with neu rosarcoidosis, the patient should be treated promptly with corticoster oids.