A Case of Neurosarcoidosis with Vertigo and Hearing Loss

Abstract

Sarcoidosis is an inflammatory multisystem disorder of unknown cause and neurosarcoidosis is a form of sarcoidosis that affects the nervous system, seen in approximately 5-7% of patients with systemic sarcoidosis. This report describes a case of neurosarcoidosis in a 69-year-old woman who suffered from vertigo and bilateral sensorineural hearing loss. Routine chest X-ray showed a pulmonary hilar lesion in the left lung. A chest CT for close inspection revealed left hilar and mediastinal lymphadenopathy, leading to broncho-alveolar-lavage (BAL) with a biopsy. Although the biopsy was negative, the BAL studies were strongly positive for lymphocytosis and a high CD4/CD8 ratio. In addition, the ACE level was high in the serum test. The patient was therefore given a possible diagnosis of neurosarcoidosis. High dose intravenous methylprednisolone pulse therapy was administrated for three courses and then tapered to the maintenance dosage. Vertigo and bilateral hearing loss were dramatically improved after the pulse therapy, but left high frequency hearing loss did not change. In this case, an inner ear disorder was suspected for the source of these symptoms with neuro-otological examinations and brain MRI finding which showed no abnormal lesion. Neurosarcoidosis must be considered when evaluating patients with atypical hearing loss and vestibulopathy.