Details
31-year-old man with many months history of confusion, gait abnormality, and episodic drowsiness. Neuroimaging shows multiple scattered leptomeningeal lesions, especially concentrated in the sellar region.
Sarcoidosis is an idiopathic systemic disease characterized by non-necrotizing granulomas in many organs and tissues. Lung and hilar lymph node involvement is most common, followed by skin and eyes. Nervous system involvement is termed neurosarcoidosis and may present as cranial or peripheral neuropathy, meningeal disease, parenchymal disease, or myelopathy. Microscopically, non-necrotizing granulomas are typically seen, but other causes of granulomatous inflammation must be excluded (as was in this case). Treatment is with steroids and immunosuppression.