Neurosarcoidosis

Involvement of the nervous system by sarcoidosis is defined by pathologic proof either directly in the nervous system or systemically with appropriate findings consistent with sarcoidosis on neuroimaging and spinal fluid examinations. CNS sarcoidosis can present without systemic manifestations. Chronic meningitis is the most common clinical presentation, but cranial neuropathy, myelopathy, peripheral neuropathy, and myopathy are all possible. MRI imaging and gadolinium enhancement of the CNS is important for diagnosis. Spinal fluid abnormalities can be used as markers of disease activity during therapy. Biopsy of abnormal lymph node, lung, skin, meninges, or brain confirms the diagnosis. Conjunctival biopsy is a reasonable site for blind biopsy in CNS cases. Corticosteroids remain the mainstay of therapy, but the use of tumor necrosis factor α-antagonists shows significant promise in treatment of refractory CNS sarcoidosis cases.