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Neurosarcoidosis associated with intracerebral haemorrhage: a challenge in diagnosis and management
  1. Mark Peter Maskery,
  2. Paul N Cooper,
  3. Adrian Pace
  1. Department of Neurology, Salford Royal NHS Foundation Trust, Salford, UK
  1. Correspondence to Dr Adrian Pace, Department of Neurology, Salford Royal NHS Foundation Trust, Salford M6 8HD, UK; adrian.pace{at}srft.nhs.uk

Abstract

Sarcoidosis is an idiopathic multisystem granulomatous disorder of unknown cause. Nervous system involvement (central and/or peripheral) is uncommon, developing in 5%–10%. The presenting symptoms are variable, reflecting the level of involvement, and frequently fluctuate and progress. Diagnosing neurosarcoidosis in people with previously confirmed systemic disease may be relatively straightforward, but diagnosing primary neurosarcoidosis is challenging. Managing neurosarcoidosis is primarily consensus based; corticosteroid is its mainstay, alongside corticosteroid-sparing agents and emerging novel therapies. We describe a 39-year-old woman who presented with cranial neuropathy. Serial imaging, cerebrospinal fluid sampling and tissue biopsy gave a diagnosis of probable neurosarcoidosis. Her clinical course was complicated by intracerebral haemorrhage following intravenous corticosteroids for neurological relapse. This is a very rare complication of neurosarcoidosis; we discuss its possible causes and suggest ways to reduce its risk.

  • neuroimmunology
  • stroke

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Footnotes

  • Contributors All the authors made a substantial contribution to conception and design, literature review, drafting of the manuscript and have reviewed and accepted the contents of the manuscript prior to submission.

  • Competing interests PNC was an expert advisor and one of the authors of the National Institute of Health and Care Excellence evidence review of infliximab.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed. This paper was reviewed by Desmond Kidd, London, UK.

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