Reply:

We thank Dr Bathla and colleagues for their comments and for sharing their experience with cerebrovascular findings in patients with neurosarcoidosis. Some of the figures in their recent article¹ show engorged and tortuous deep medullary veins that are similar to what we have described. We are glad to see that their study and ours share some common observations and agree that larger studies may be able to elucidate the clinical significance of this finding. As Dr Bathla and colleagues point out, it is reasonable to think that venous engorgement may be an effect of inflammation; however, we could not prove this in our study due to lack of histologic data. Their anecdotal experience of patients with mild engorgement showing improvement after therapy is also interesting. Although we do not have sufficient long-term data, the 5 cases that we could follow did not show any change in venous engorgement after treatment. This is something that could be explored in a future study.

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