Psychic and behavioral troubles with good outcome during neurosarcoidosis

Introduction, - Neurological involvement is observed in 5% of cases of sarc oidosis and includes impairment of the central nervous system, the meninges , and the cranial and peripheral nerves. Besides neurological defects, cogn itive impairment may be encountered ranging from isolated memory defect to dementia. Exegesis, - We report a case of neurosarcoidosis occurring in a 40-year-old woman, a native of Reunion Island, with initial meningeal and hypophyseal involvement. Three years later, while treated with low dose prednisolone an d methotrexate, she presented a paranoid state associated with cognitive im pairment of frontal type and severe behavioral disturbances. After 2 years of high dose steroid treatment associated with hydroxychloroquine, her beha vioral status improved, allowing social and familial reinsertion. Conclusion. - In our observation sarcoidosis was revealed through a central neurological impairment, with chronic meningitis, facial nerve palsy, and, finally, through psychiatric symptoms and severe behavioral disturbances A slow favorable outcome was obtained using high dose melhylprednisolone and hydroxychloroquine with fetal regression of behavioral disturbances but wi th persisting cognitive alteration. (C) 2001 Editions scientifiques et medi cales Elsevier SAS.