Neurosarcoidosis. Difficulties of diagnosis

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Objective: to present a clinical case of neurosarcoidosis demonstrating the difficulties in diagnosing this disease and to discuss the features of its clinical manifestations, diagnosis, and treatment. Materials and Methods. A clinical case of a 28-year-old patient with neurosarcoidosis is described. The diagnostic process included clinical examination, laboratory tests, neuroimaging (CT and MRI of the brain), lymph node biopsy with histological and immunohistochemical examination, and autopsy. Results. The patient presented with symptoms such as severe headache, disorientation, anisocoria, sensory impairment, epileptic seizures, and psychomotor agitation. Brain MRI revealed leptomeningeal enhancement of the contrast agent. Lymph node biopsy confirmed granulomatous lymphadenitis characteristic of sarcoidosis. Despite the recommended glucocorticoid therapy, the disease progressed, and the patient died due to cerebellar infarction and cerebral edema. Autopsy verified sarcoidosis with involvement of the leptomeninges, spleen, and lymph nodes. Conclusions. Neurosarcoidosis is a rare disease with diverse clinical manifestations, making timely diagnosis challenging. A comprehensive approach, including clinical examination, neuroimaging, histological examination, and exclusion of other diseases, is crucial for establishing the diagnosis. Timely initiation of immunosuppressive therapy may improve the prognosis of the disease.