Neurosarcoidosis. Review of the literature

Sarcoidosis is a. systemic granulomatous disease of unknown etiology. The f requency of neurologic manifestations varies from 5 to 15 % of cases. Syste mic manifestations of sarcoidosis ale often present and the diagnosis is st ill based on histopathological studies. In nearly half of the patients no s ystemic manifestations are found and the diagnosis of sarcoidosis may be di fficult Main neurologic involvements are cranial and peripheral nerve lesio ns. Other manifestations include aseptic meningitis, hydrocephalus, parench ymatous granulomata of the central nervous system, hypothalamic dysfunction and myopathies. There is more than one manifestation of neurosarcoidosis i n 30 % of the patients. Lumbar puncture is useful to rule out other disease s but CSF changes are not specific, neither elevated serum angiotensin conv erting enzyme levels. Computed tomography is helpful, bur magnetic resonanc e imaging is the best diagnostic fool. The granulomatous nature of the dise ase can only be confirmed by tissue sampling and brain biopsies are sometim es required. There have been no controlled trials of treatment for neurosar coidosis but corticosteroids are the main stay of therapy. The prognosis is often good and 55 % of patients reported have had a complete recovery. In case of failure, immunosuppressive and radiation therapy can be used. Surge ry is indicated to establish tissue diagnosis, in the presence of increased intracranial pressure, or to remove brain tumor.