Article Figures & Data
Figures
- Fig 1.
Dural involvement in sarcoidosis. A, Contrast-enhanced axial T1-weighted image shows focal dural thickening and enhancement involving the right tentorium (arrow). B, Axial T2-weighted image shows marked T2-hypointensity of dural thickening (arrow), characteristic of sarcoidosis.
- Fig 2.
Extra-axial masses in sarcoidosis. A and B, Axial T2- and enhanced axial T1-weighted images demonstrate an enhancing T2-hypointense extra-axial mass in the left cerebellopontine angle cistern (arrow). C and D, Coronal T2 and enhanced coronal T1 images from a different patient show a T2-hypointense enhancing right tentorial mass (arrow). Noncontrast CT (not shown) did not demonstrate any calcification. Biopsy (not shown) revealed granulomatous inflammation.
- Fig 3.
Leptomeningeal involvement in sarcoidosis. A and B, Enhanced axial and coronal T1-weighted images demonstrate nodular leptomeningeal enhancement in the basilar cisterns and posterior fossa. C and D, Enhanced axial T1-weighted images in a different patient demonstrate nodular leptomeningeal enhancement along the cerebellar folia (arrows). Involvement of perivascular spaces is seen at a higher level in D (arrow).
- Fig 4.
Cranial nerve enhancement in sarcoidosis. A and B, Axial fat-suppressed T1 images show enhancement of the left optic nerve (thin arrow). Lacrimal and parotid glands are enlarged (thick arrows in A and B, respectively). C, Bilateral trigeminal nerve enhancement is seen in a different patient (arrows). D, Enhancement of bilateral seventh-eighth nerve complexes is seen in another patient (arrows).
- Fig 5.
Parenchymal lesion in sarcoidosis. A and B, Enhanced axial T1- and T2-weighted images at presentation demonstrate an enhancing T2-hypointense left frontal mass (arrow). There is surrounding nonenhancing T2-hyperintensity due to vasogenic edema. Also note thin dural enhancement overlying both frontal lobes. C, Noncontrast CT scan obtained 1 year later shows worsening lesion size and edema (arrow). The patient had been on low-dose prednisone and was symptomatically stable. D, MR image obtained following high-dose prednisone therapy shows a decrease in edema but only partial resolution of the enhancing left frontal mass (arrow). There was no further decrease in size of the mass on serial scans during the next 2 years with the patient on immunosuppressive therapy.
- Fig 6.
Spinal cord involvement in sarcoidosis. A−C, Enhanced parasagittal and axial T1-weighted images of the cervical cord show multiple enhancing parenchymal nodules (arrows). The peripheral distribution of these nodules, which are abutting the surface of the cord, suggests a leptomeningeal origin of these nodules. Note enhancement extending along the nerve roots (open arrow, C).
- Fig 7.
Sellar-suprasellar involvement in sarcoidosis. A, Enhanced coronal T1-weighted image shows an enlarged and enhancing pituitary infundibulum (arrow). This patient also had multiple enhancing parenchymal nodules in a perivascular distribution. B, Enhanced coronal T1-weighted image from a different patient shows a homogeneously enhancing infundibular and hypothalamic mass (arrow).
Tables
- Table 1:
Final diagnoses of patients initially suspected of having neurosarcoidosis but found to have other conditions on biopsy or follow-up
Diagnosis No. Fungal meningitis 4 Tuberculous meningitis 2 Wegener granulomatosis 1 Transverse myelitis 1 Vasculitis 1 Chronic inflammatory demyelinating polyneuropathy 1 Lymphoma 3 Acute disseminated encephalomyelitis 1 Meningeal fibrosis 1 Erdheim-Chester syndrome/polyostotic sclerosing histiocytosis 1 Glioma 2 Presentation No. (%) Headache 10 (31) Visual impairment 9 (28) Seizures 8 (25) Diplopia 5 (16) Numbness or paresthesias 4 (12) Memory change 3 (9) Hypopituitarism 3 (9) Hearing impairment 2 (4) Dysphagia 2 (4) Muscle weakness 2 (4) Psychosis 1 (2) Movement disorder 1 (2) Increased intracranial pressure 1 (2) Altered sensorium 1 (2) Finding/Symptom No. Dural disease Headache 2/11 Visual impairment 1/11 Symptoms not explained by imaging findings 8/11 Cranial nerve involvement Visual impairment 6/11 Diplopia 1/11 Symptoms not explained by imaging findings 4/11 Leptomeningeal disease Headache 4/10 Seizures 2/10 Symptoms not explained by imaging findings 4/10 Enhancing parenchymal lesions Altered sensorium 1/7 Seizures 3/7 Memory changes 1/7 Symptoms not explained by imaging findings 2/7 Spinal lesions Motor and/or sensory symptoms 3/8 Symptoms not explained by imaging findings 5/8 Pituitary lesions Endocrine insufficiency 3/3 Finding Complete or Near-Complete Resolution Stable or Minimal Improvement Worsened Could Not Be Assessed Total Dural 6 5 0 0 11 Leptomeningeal 6 1 1 2 10 Cranial nerve 9 1 0 1 11 Enhancing parenchymal 3 3 1 0 7 Nonenhancing white matter 0 4 0 0 4 Sellar-suprasellar-infundibular 4 2 0 0 6 Spinal 5 1 0 2 8
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