Presentation
Past medical history of neurosarcoidosis found unresponsive, febrile, tachycardic and tachypneic. Normal WBC. EEG suggests encephalopathy. Patient intubated and started on antibiotics.
Patient Data
Increased hypodensity within the midbrain extending into the bilateral basal ganglia white matter/internal capsules.
Further assessment with MRI is recommended.
Signal change in the pons and midbrain structures and abnormal enhancement involving these areas with extension into the leptomeningeal surfaces associated with the interpeduncular fossa.
Signal abnormality of the corpus callosum splenium with associated enhancement is also noted on the left and central distribution posteriorly.
Overall findings are consistent with progression of the patient's given history of neurosarcoidosis.
Case Discussion
The original diagnosis of neurosarcoidosis was made after ruling out other possibilities, imaging findings, and positive response to treatment. Diagnosis has not been confirmed via biopsy.
Neurosarcoidosis is present in about 5% of patients with sarcoidosis. This case highlights the common neurosarcoidosis imaging finding of leptomeningeal involvement (present in about 40% of cases).
This case also demonstrates the severe effects of neurosarcoidosis that may mimic signs of meningitis.
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