NEUROSARCOIDOSIS PRESENTING AS AN INTRACR ANIAL MASS IN A 13 YEAR-OLDCHILD - DIFFICULTIES IN DIAGNOSIS AND TREATMENT

In systemic sarcoidosis, neurologic manifestations are possible and oc curred in 5 p. 100 of cases. The diagnosis is easier when sarcoiddosis is known, but in half case neurologic symptoms are inaugural. In thes e cases, involvement of other sites (liver, lung, eyes or skin) by the disease is needed to confirm sarcoidosis. Main manifestations in neur osarcoidosis are cranial nerve palsy, diabetes insipidus or chronic as eptic meningitis, but sometimes sarcoidosis can present as an intracra nial mass. The diagnosis of neurosarcoidosis may be difficult and coul d be confused with infection (such tuberculosis or mycosis), with infl ammatory diseases (such multiple sclerosis) or with neoplasm, particul arly in case of oedema. Brain biopsy may be necessary in isolated neur osarcoidosis if no peripheral histology evidence of noncaseating granu lomas has been obtained Treatment with steroids alone is the best choi ce for initial therapy but must be prolonged. It is difficult to predi ct accurately the response to steroids and relapse may be possible aft er a long time. Other immunosuppressive therapeutics or radiotherapy h ave been used in patient with refractory neurosarcoidosis. Sequential magnetic resonance imaging is the useful mean for the followup of neur osarcoidosis.