Sarcoidosis of the Nervous System

Neurologic manifestations occur in around 5 percent of patients with sarcoidosis. Neurosarcoidosis can manifest in many ways including with cranial neuropathy, aseptic meningitis, mass lesions, encephalopathy-vasculopathy, seizures, hypothalamic-pituitary disorders, hydrocephalus, myelopathy, peripheral neuropathy, and myopathy. Because its etiology is unknown, its neurologic manifestations are so diverse, and its diagnosis cannot be confirmed readily by laboratory tests, neurosarcoidosis poses many clinical challenges. Its diagnosis is usually based on the identification of characteristic neurologic findings in an individual with proven systemic sarcoidosis. Although corticosteroids are the basis of treatment, they are not always successful and have potentially serious side effects. Immunosuppressive agents and anti-TNF-α agents are increasingly being used to manage the disorder in addition to corticosteroids. Optimal management of patients with neurosarcoidosis benefits from an understanding of the broad clinical spectrum of the disorder, the strategies to best confirm a diagnosis, and the full range of treatment options.