Progressive Cognitive Decline in a Patient With Isolated Chronic Neurosarcoidosis

Abstract

Central nervous system manifestations of sarcoidosis are diverse. Cognitive decline is a recognized manifestation of neurosarcoidosis, yet detailed descriptions of this topic are limited in the literature. A 44-year-old man with long-standing isolated neurosarcoidosis presented with a 7-year history of progressive cognitive decline in multiple domains. Known manifestations of this patient's neurosarcoidosis included panhypopituitarism, seizures, and ventricular loculation, which required shunt placement. He had required ongoing immunosuppression for treatment. The patient's neuropsychological profile confirmed decline in multiple cognitive domains affecting memory, basic and more complex attention skills, processing speed and flexibility, perceptual and constructional skills, and aspects of abstract thinking and problem-solving. His gross cognitive status was borderline, with relative preservation of verbal skills, and significant impairment of visuospatial skills. Overall, this patient's neuropsychological profile was suggestive of diffuse involvement, with frontal/ subcortical mechanisms appearing predominantly affected, perhaps with greater involvement of right hemisphere systems. This patient's progressive cognitive decline was attributable primarily to ongoing inflammatory disease from neurosarcoidosis. This case is discussed in the context of the existing literature on cognitive impairment and neurosarcoidosis, and adds to the small body of literature surrounding the chronic neurologic manifestations of this disease.