Neurological lesions of sarcoidosis

OBJECTIVE: Study the incidence, clinical features, prognosis and diagnostic and therapeutic strategies in neurological lesions of sarcoidosis. PATIENTS AND METHODS: The 207 cases of sarcoidosis followed at the Grenoble University Hospital between 1992 and 1998 were identified. After collectin g data, the cases with neurological signs related to sarcoidosis were selec ted. RESULTS: Sixteen patients (7.7%) had neurosarcoidosis. Ten had central nerv ous system involvement, with 5 reaching the hypothalamus and pituitary glan ds, 2 cases of meningoencephalitis, 2 pseudotumoral lesions, and 1 bitempor al lesion. Six had peripheral nervous system involvement, 3 had facial pals ies and 3 had neuropathies. Laboratory tests were not contributive to diagn osis. Ten magnetic resonance imaging series were pathological out of 11 per formed. Three central nervous system biopsies were obtained. Corticosteroid therapy was the most frequent treatment. For hypothalamic and pituitary dy sfunction, the only treatment was substitutive hormone therapy. The course was favorable in 11 cases, stable in 4 cases. Symptoms worsened despite tre atment in only 1 case. CONCLUSION: The incidence of neurosarcoidosis may be much higher than is ge nerally realized. The association of suggestive MRI signs, and clinical and laboratory findings evoke the diagnosis. Brain biopsy remains necessary fo r the pseudotumoral forms and the primitive neurological forms.