Neurosarcoidosis Presenting as Young-Onset Chronic Headache: A Case Report

Abstract

Sarcoidosis causes granulomatous inflammation in multiple organ systems. Lungs are the most commonly affected organs. In 50% of the cases with lung involvement, other organs are also involved. The central nervous system is one of the rarer organ systems involved – comprising 5–15% of all the cases. Neurological involvement, when present, can affect virtually every part of the central and peripheral nervous system. We present an interesting case of a 30-year-old nonalcoholic, nonsmoker man who presented with a chronic headache of 6 years. He had a recent swaying of the body for 6 months and mild forgetfulness for 4 months. The patient had 2 episodes of facial nerve palsy in the past – which had responded to the treatment of Bell’s palsy; however, the patient had some residual findings on presentation. While CSF findings suggested meningeal tuberculosis, the radiological evidence and biopsy confirmed the diagnosis of neurosarcoidosis. On follow-up after 6 weeks of steroid therapy, the patient displayed a marked improvement in headache, cognitive function, and a good response on imaging studies. Our case emphasizes that neurosarcoidosis should be considered in the differential diagnosis of chronic headaches and recurrent facial nerve palsy despite being very rare.

Worsening Paraparesis: A Diagnostic Dilemma for Neurosarcoidosis

“…The central lesions commonly present with headaches, disturbances in vision, auditory dysfunction, and various cranial nerve involvement with facial nerve being the most commonly affected [9]. Along with these, focal neurologic deficits have been reported in the setting of generalized seizures and encephalopathy, as well as spinal cord lesions leading to radiculopathies and myelopathies [10]. The skull base is the most common location to be affected and identified with non-caseating granulomas on biopsy [11].…”

Common Clinical and Molecular Pathways between Migraine and Sarcoidosis

“…In a univariate regression, the only variable that was associated with the diagnosis of migraine was the female sex (OR: 2.7; 95% CI: 1.02-6.84). A few case reports have described patients with sarcoidosis and a migraine-like headache [35], while in other cases, the description of the headache does not allow its classification [36][37][38][39]. Sarcoidosis could be another comorbidity of migraine, since its frequency seems to be twice as high as what is expected to occur by chance [11].…”