Neuroradiology case of the day. Neurosarcoidosis

Extra-pulmonary manifestations of sarcoidosis

Although, the diagnosis and evaluation of sarcoidosis has traditionally remained confined to the chest, its multi-system nature has been widely recognized. Radiological features of pulmonary sarcoidosis are well known but extra-pulmonary manifestations can produce a plethora of non-specific imaging findings that can affect subcutaneous tissue, and the neurological, cardiac, gastrointestinal, urological, liver, spleen, and skeletal systems. In the literature, there are various case reports and specific system reviews but there are few reviews that encompass all the extra-pulmonary manifestations. In this paper, we comprehensively review the imaging features of extra-pulmonary sarcoidosis with characteristic features as well as atypical presentations. In addition, we discuss the emerging role of nuclear medicine in sarcoidosis.

[Sarcoidosis with systemic involvement: a report of two cases]

Sarcoidosis is a multisystemic granulomatose disease of unknown origin that most often affects the lung parenchyma and the mediastinal lymph nodes. Although less common, involvement of the abdominal organs and the central nervous is also possible. We present the radiological findings observed in two patients diagnosed with sarcoidosis with systemic involvement. In one case, the disease affected the lung, spleen, mediastinal and abdominal lymph nodes, whereas in the other case it affected the lung, spleen, abdominal lymph nodes and central nervous system. The aim of this report is to review the radiologic manifestations of this disease.

Neurosarcoidosis which manifested as acute hydrocephalus: diagnosis and treatment

Neurosarcoidosis is generally expressed by various symptoms; it is exceptionally revealed by hydrocephalus. We report a 27-year-old African man hospitalized with acute neurological deterioration due to hydrocephalus. The treatment consisted of ventriculostomy and corticosteroid therapy; however a permanent shunt was not required. After six months of follow-up, the patient had fully recovered. Clinical presentation, neuroimaging findings and treatment modalities are discussed.

Role of radiology in the diagnosis of neurosarcoidosis

Clinical studies report a rate of 5% and autopsy results a rate of 25% of brain involvement in sarcoidosis. The aim of this study was to evaluate the role of radiology in the diagnosis of patients with neurosarcoidosis. The chest radiographs and MRI brain scans of 22 patients with sarcoidosis were retrospectively reviewed, along with the information that was provided in the request form and clinical charts. All patients had neurological signs and symptoms; 21 patients were examined with contrast enhancement. Facial nerve paralysis was the most common clinical manifestation identified in 10 patients. A wide spectrum of MR findings was noted: periventricular high-signal lesions on T2-weighted images (46%); multiple supratentorial and infratentorial brain lesions (36%); solitary intra-axial mass (9%); solitary extra-axial mass (5%); and leptomeningeal enhancement (36%). Neurological signs and symptoms can be significant manifestations of sarcoidosis. Magnetic resonance imaging shows a wide spectrum of brain abnormalities associated with neurosarcoidosis. The patient's history and chest X-ray are helpful in arriving at the correct diagnosis, but in selected cases with isolated brain involvement biopsy may still be required.