A 52-year-old man experienced a relapse of neurosarcoidosis, characterised by obstructive hydrocephalus and multiple posterior circulation infarcts. He was taking methotrexate, but his prednisolone was being weaned because of adverse effects. Stroke is rare in neurosarcoidosis and typically relates to granulomatous inflammation with a predilection for the perforator arteries. Sarcoidosis generally responds well to corticosteroids; however, patients with leptomeningeal involvement usually require additional immunosuppression as relapses can occur on weaning of corticosteroids. It is worth considering tumour necrosis factor-α antagonists for cases that progress despite first-line therapy.
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Contributors MJH performed a literature search and review and drafted the article. GP and MDC provided clinical expertise and critical appraisal of the article.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests MJH and GP have no acknowledgements to make in terms of financial support. MDC has received consulting fees, lecture fees and travel grants from Sanofi Genzyme, Biogen and Merck Serono.
Patient consent Not required.
Provenance and peer review Not commissioned; externally peer reviewed by Neil Scolding, Bristol, UK.