Nervous system involvement by sarcoidosis has been considered rare, yet more than 400 cases have been reported. We present 23 additional cases here, including 14 with autopsies, and we review the literature. The overall frequency of neurologic involvement is 5%. Patients usually have other stigmata of sarcoidosis; however, neurologic dysfunction is frequently the presenting finding. The protean manifestations of central nervous system (CNS) involvement usually occur in the early phase of the disease, while those of peripheral nervous system and skeletal muscle involvement are characteristically seen in the chronic stages. Basal granulomatous meningitis causes most of the CNS manifestations either by infiltration or compression of adjacent structures. Steroids are the mainstay of therapy, and the overall response is quite variable. The course is also variable, being transient in some and chronic in others. The prognosis is better with peripheral than with central nervous system involvement.

Intracranial hemorrhage (ICH) occurred in a drug abuser soon after self-administration of amphetamine. Other reported cases indicate a consistent clinical picture, sometimes fatal or causing permanent neurologic disability.

The neurotoxicity of the Vinca alkaloids vincristine and vinblastine is well recognized. Less recognized is laryngeal nerve paralysis induced by these chemotherapeutic agents. This potentially dangerous paralysis is usually reversible when the drug is withdrawn, but other causes of hoarseness in a cancer patient must be considered. I add two cases to 19 previously documented.

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Biologic false positive serology in cerebrospinal fluid has been reported as exceedingly rare. In a patient with a spinal cord tumor and elevated cerebrospinal fluid protein, the cerebrospinal fluid was reactive to VDRL and fluorescent treponemal antibody absorption (fta-abs) tests, but became nonreactive with removal of the tumor. This biologic false positive reaction may be related to the elevated cerebrospinal fluid protein, as similar false positive reactions have occurred in blood with abnormal or elevated proteins. Cerebrospinal fluid reactive to the VDRL and FTA-ABS tests does not always indicate neurosyphilis.