Chapter 45 - Neurosarcoidosis

Abstract

The chapter presents a discussion on neuroarcoidosis. Sarcoidosis is a disease of unknown etiology featured pathologically by noncaseating granulomas. The diagnosis is most secure if inflammation can be documented in multiple organ systems. Sarcoidosis most commonly affects intrathoracic structures. Neurologic disease develops in five percent of patients with sarcoidosis. The chapter outlines the different neurologic manifestations of sarcoidosis and selected differential diagnostic considerations. Patients with known systemic sarcoidosis who develop an illness compatible with the neurologic manifestations of sarcoidosis should be evaluated to reasonably exclude other disease entities, particularly infection and neoplasia. If the patient does not respond as expected to treatment for neurosarcoidosis, the diagnosis should be questioned and a more extensive diagnostic evaluation pursued. If a patient without documented sarcoidosis develops an illness compatible with neurosarcoidosis, the patient should be evaluated for multisystem inflammation. Sarcoidosis mostly affects the lungs, lymph nodes, skin, and eyes. Ocular findings include lacrimal gland inflammation, conjunctival nodules, iritis, uveitis, retinal lesions, and optic disc pathology. The preferred imaging modality to evaluate central nervous system (CNS) sarcoidosis is a gadolinium-enhanced magnetic reasonance imaging (MRI). The chapter discusses peripheral facial nerve palsy, chronic corticosteroid therapy, and several other alternative medications.