Neurosarcoidosis: rare initial presentation with seizures and delirium

Abstract

A previously healthy 37-year-old African-American man presented to the emergency department with a seizure. The seizure was generalized, tonic clonic and lasted for 15 s, followed by loss of consciousness for about 30 min. There was no history of tongue biting, bowel or bladder incontinence. The patient reported ongoing headache accompanied by nausea for 2 months prior to hospital admission. The headache was diffuse, dull and episodic lasting 3–30 min. The headache worsened with bright light and he denied blurring of vision or vomiting. He reported a weight loss of 20 pounds in 1 month. He denied neck stiffness and sensitivity to light or sound. He had no known drug allergies and was not on any medications at the time of admission. There was no known family history of neurologic disease. He smoked cigars, drank alcohol occasionally, but did not use recreational drugs. He was in a monogamous relationship. Physical examination revealed that the patient was lethargic, oriented with slow response to questions. His temperature was 36.4°C, pulse rate was 86/min and oxygen saturation was 98%, while he was breathing ambient room air. His pupils were equal and reactive to light and accommodation. Cranial nerves II to XII were intact. The neck was supple. Muscle bulk and tone were normal. Muscle strength was 5/5 in all the four extremities. Deep tendon reflexes were 1+ and symmetric, and the plantar responses were flexor. There was no incoordination on …