Dementia, gait disturbance, and urinary incontinence in a patient with pulmonary sarcoidosis

Abstract

Hydrocephalus is an uncommon presentation of neurosarcoidosis. We discuss the case of a 67‐year‐old woman with a prior diagnosis of hypothyroidism, systemic hypertension, and lung sarcoidosis who presented with a 1‐month history of progressive impairment of consciousness leading to prostration and loss of sphincter control. At admission, patient was febrile with altered speech and without focalization. Laboratory results showed leucocytosis and mild anaemia. Cerebrospinal fluid (CSF) analysis was characterized by mild elevated protein level, increased cell count, normal glucose and adenosine deaminase (ADA), negative cytology, and no bacterial isolations. Electroencephalogram showed toxic‐metabolic encephalopathy. Computed tomography (CT) of the brain revealed hydrocephalus without structural damage, and magnetic resonance imaging of the brain demonstrated non‐specific diffuse meningeal enhancement and periventricular changes supporting normal pressure hydrocephalus. Chest X‐ray showed mediastinal adenopathy and parenchymatous lesions, consistent with stage II lung sarcoidosis. A ventriculoperitoneal shunt was installed, and the patient experienced rapid improvement in her symptoms.

Neurosarcoidosis Presenting with Obstructive Hydrocephalus Successfully Treated with Endoscopic Third Ventriculostomy

“…Neurosarcoidosis patients with obstructive hydrocephalus are treated with either ventriculoperitoneal (VP) shunt, steroid therapy, or both (3-5). However, this tends to cause infection by artifacts and steroid use.…”