Stephen Howard, n/a
Medical Student
Lake Erie College of Osteopathic Medicine
Norwalk, Connecticut, United States
Ryan Tam, DO
Medical Student
Lake Erie College of Osteopathic Medicine
Rochester, New York, United States
Sarcoidosis is a multisystem disease in which multiple non-caseating granulomas are present within various organs without a known trigger, commonly affecting the lungs and the lymphatic system. Sarcoidosis that affects the nervous system is uncommon and occurs in approximately 5 to 10% of patients with sarcoidosis. To diagnose neurosarcoidosis definitively, a biopsy must be done on an organ in the nervous system showing granulomatous inflammation.
Case Description:
A 57-year-old African American male presented to the emergency department with worsening bilateral lower extremity weakness and numbness. Physical examination was remarkable for right eye ptosis with the right pupil being asymmetrically dilated and fixed when compared to the left pupil. Additionally, the patient had difficulty voiding; therefore, a Foley catheter was inserted. Magnetic resonance imaging of the brain demonstrated small foci of enhancement along the posterior left temporal and left occipital lobes with an associated leptomeningeal enhancement and computed tomography imaging of the chest revealed mediastinal and hilar lymphadenopathy. With a high suspicion of neurosarcoidosis, cervical mediastinoscopy procedure was performed that showed scattered ill-formed non-necrotizing epithelioid cell granulomas, thereby further confirming the diagnosis.
Discussions:
Cranial neuropathy is the most common manifestation within the subset of neurosarcoidosis, with the facial nerve most affected. The combination of acute onset of bilateral leg weakness with simultaneous urinary voiding difficulties in a patient with oculomotor nerve palsy has never been reported in literature. Comprehensive rehabilitation therapy with the involvement of physical therapy, occupational therapy, and physiatry specialists have demonstrated greater recovery of functional status with noted clinical improvement.
Conclusions:
This case report provides education to broaden the differential diagnosis for physicians. An early diagnosis of neurosarcoidosis will significantly benefit patients with this condition so that specific treatment can be directed with an interdisciplinary team approach to assist patients on their way to making meaningful functional recovery.
