Micturitional disturbance in a patient with neurosarcoidosis

We report a ease of neurosarcoidosis in which urodynamic studies showed neu rogenic bladder dysfunction. A 30-year-old man began to have slowly progres sive gait ataxia of vestibular origin, deafness, and hallucination, which d eveloped into versive seizure and stupor. Brain computed tomography and mag netic resonance imaging showed the anteromedial frontal lube lesion with mi ld ventricular enlargement. The cerebrospinal fluid examination revealed pl cocytosis with raised total protein and angiotensin-converting enzyme level s. Endoscopic lung biopsy showed epithelioid granuloma. Oral prednislone (6 0 mg/day) ameliorated his symptoms. After tapering steroids, however, he de veloped urinary urgency, frequency, urge urinary incontinence, and a relaps e of gait ataxia. The urodynamic study showed detrusor hyperreflexia. Predn isolone treatment again improved his urinary and neurological symptoms. The anteromedial frontal lobe lesion seems to be responsible for the micturiti onal disturbance in our patient with neurosarcoidosis. (C) 2000 Wiley-Liss, Inc.