Case of isolated neurosarcoidosis requiring differentiation from tuberculous meningitis

Abstract

A 62-year-old woman was transported to our hospital for management of generalized clonic seizures. Cerebrospinal fluid examination showed an increased monocyte-dominant cell count, high protein concentration, and low glucose concentration that was 17% of the plasma glucose concentration. Contrast-enhanced cranial magnetic resonance imaging revealed diffuse leptomeningeal enhancement with multiple nodular lesions. She underwent examinations that ruled out the following conditions: tuberculous meningitis, systemic sarcoidosis, malignant lymphoma, carcinomatous meningitis, and central nervous system vasculitis. On hospital day 13, dural and brain biopsies revealed neurosarcoidosis, for which steroid therapy was administered. Thereafter, imaging examinations showed marked improvement. Because isolated neurosarcoidosis is difficult to diagnose, early pathologic diagnosis may be essential.

Isolated Neurohypophysial Sarcoidosis Involving the Cavernous Sinus Mimicking a Malignant Tumor

“… 9 ) Furthermore, Deguchi et al have reported a case of NS requiring differentiation from tuberculous meningitis. 10 ) Based on the finding by Kidd et al, who have reported that 14% and 40% of the patients with NS had pachymeningeal and leptomeningeal lesions, respectively, 2 ) NS can have pachymeningeal and leptomeningeal lesions mimicking malignant tumors or other diseases. Furthermore, the patient in this case report had a large invasive mass lesion at the neurohypophysis involving the bilateral cavernous sinus besides the pachymeningeal and leptomeningeal lesions, making it difficult to distinguish NS from a malignant tumor.…”

Acute central nervous system vasculitis as a manifestation of neurosarcoidosis: A case report and literature review

“…Biopsy of a CNS lesion gave us macroscopic pathological information. Till date, there is just one report on brain surface findings of meningitis due to NS, where yellowish and cloudy discoloration was observed [4] . To the best of our knowledge, our case is the first to report multiple small hemorrhages observed on the brain surface due to NS.…”

“…Sarcoidosis is a very rare disease affecting 0.01%-0.02% of the global population, and the infrequent event of sarcoidosis affecting solely the central nervous system (CNS) is defined as an isolated neurosarcoidosis (INS) [1] , [2] , [3] . INS usually progresses slowly and exhibits a variety of clinical manifestations, making timely, and transparent diagnosis difficult in most cases [2 , 4 , 5] . Herein, we describe the case of a 71-year-old woman presenting with atypical INS radiological images and clinical course.…”