Radiological findings in neurosarcoidosis

Abstract

The radiological investigation of neurosarcoidosis is discussed in relation to a series of 32 patients presenting to a neurological hospital. Cranial computed axial tomography, performed in 13 of these cases, was the most frequently positive procedure (77%). The indications for air studies are now limited but in cases with nerve or chiasmal syndromes and negative CAT they may show small mass lesions, or incomplete filling of basal cisterns due to granulomatous infiltration or fibrosis. Sarcoid masses are avascular and angiography is only useful for exclusion of incidental tumours with pathological circulation. Cord syndromes were present in eight cases, but myelography was only indicated in five of these and was normal in three. The cord may be involved by intra-medullary granulomas or meningeal infiltration causing arachnoiditis, both of which cause myelographic abnormalities though these are not specific for sarcoidosis.

Hypothalamic-pituitary disease as the sole manifestation of sarcoidosis

“…A major problem concerns the monitoring of her progress. The CT scan is reputed to be the most useful investigation in cases of CNS sarcoidosis, (Kendall and Tatler, 1978) but this investigation was not very helpful in our case. We continue to assess visual field perimetry and look for systemic involvement at regular intervals.…”

Intrathecal production of oligoclonal IgM and IgG in CNS sarcoidosis

“…A CT finding similar to that in our patient has been observed in one case of myeloid metaplasi, in a patient with myelofibrosis (18) and in one with tuberculous meningitis (S. Cronquist, personal communication). In CNS sarcoidosis, the most frequent pathological finding on C T scan is hydrocephalus, and when contrast enhancement has been found in meningeal structures, it has been confined to basal meninges (19).…”

Identical twins with papilloedema and cranial nerve palsies.

“…Computerised tomography (CAT) is the most informative neuroradiological study with the granulomata showing as high attenuation lesions homogeneously enhancing with little surrounding oedema. The CAT scan was positive in 77% of cases of neurosarcoidosis (Kendall and Taylor, 1978). With availability of CAT scanning there remain few indications for angiography or air studies.…”