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Sarcoidosis

Brain MRI consistent with Sarcoidosis?

09/02/2008

Question:

I have suffered with "Mystery Illness" for the past 2 years. I won`t get into all the details but we are now looking into Sarcoidosis. I have had numerous transcient facial palsies, reactivated surgical incision, feeling of ice pick in ear, granuloma annulare, etc. My CSF shows elevated protein and high red blood cells. My question is my brain MRI states: 7 mm ovoid focus of increased T2/FLAIR signal present within the subcortical white matter posterior left frontal lobe. Could this be consistent with Neurosarcoidosis? With much appreciation of your help.

Answer:

The diagnosis of neurosarcoidosis is difficult to make, particularly if there are no other signs of sarcoidosis outside of the central nervous system. The clinical manifestations that you describe and the finding of "white matter" lesions on "T2-weighted MRI images" are consistent with sarcoidosis, but are not diagnostic. The diagnosis of sarcoidosis is usually confirmed by obtaining tissue biopsies. However, in the case of neurosarcoidosis, this approach has obvious hazards. Thus, we usually look for signs of disease outside of the central nervous system to obtain biopsy material. The cerebrospinal fluid (CSF) is often helpful. Neurosarcoidosis often presents with elevated proteins, and increased numbers of specific inflammatory cells (T helper type lymphocytes). The CSF pressure may also be high. The finding of blood in the CSF is not typical of sarcoidosis.

Given the difficulties relating to confirming the diagnosis of neurosarcoidosis, it is not uncommon to treat "presumptively" for neurosarcoidosis if the clinical presentation is highly suggestive. If that is the case, your doctors will continue to follow you closely to determine if the treatment is effective. If the usual treatments rendered for sarcoidosis are not effective, it may be necessary to reconsider the diagnosis of sarcoidosis.

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Response by:

Elliott D Crouser, MD Elliott D Crouser, MD
Associate Professor of Pulmonary, Allergy, Critical Care & Sleep Medicine
College of Medicine
The Ohio State University