Mistaken Identity: A Case Report of Neurosarcoidosis Presenting with Pachymeningitis

Abstract

Pachymeningitis is an interesting and rare presentation of neurosarcoidosis, a systemic disease characterized by granulomatous inflammation of one or more neurologic structures. This case report describes a 39 -year-old female who presented with 1 week of paresthesias and weakness of the upper and lower extremities that eventually resulted in a fall. On presentation, the patient was initially diagnosed with posterior subdural hematoma of the brain secondary to trauma. Because of the patient's presentation of weakness and paresthesias prior to fall, and a reported prodrome of increased fatigue, the patient underwent MRI brain and cervical spine during her hospitalization which revealed patchy dural enhancement of the brain and patchy intramedullary and leptomeningeal enhancement of the spinal cord most consistent with a multifocal inflammatory process. Nerve conduction studies were also performed to exclude a mononeuritis multiplex, which were negative. The patient was diagnosed with neurosarcoidosis given her symptoms and corresponding imaging findings, and she was started on systemic steroids and infliximab infusion with progressive improvement of her symptoms. Given this patient's widespread disease, this case presents an interesting challenge for the rehabilitation team.