Figure 1: In this case, there are multiple scattered foci of FLAIR hyperintense signal (left) with corresponding enhancement (right) in the cerebral parenchyma. More commonly, you will see superficial pachymeningeal or leptomeningeal enhancement with enhancement and thickening of the pituitary gland, infundibulum or cranial nerves.
- Idiopathic systemic granulomatous disease with 5% of sarcoid patients developing symptoms
- Roughly 10% of patients with sarcoid will have neuroimaging findings, though not all will be symptomatic
- Epithelioid granulomas without caseation or staining for infectious agents
- Granulomas often incorporate into multinucleated giant cells and lymphocytes
- Highly variable
- Dependent on site of involvement
- Range from hydrocephalus, cranial nerve palsies, endocrinopathies, seizures, paresthesias, to myelopathy
- Most commonly presents in the third to fourth decade of life
- Most commonly afflicts African Americans
- Hydrocephalus and/or pachymeningeal, leptomeningeal, or parenchymal findings
- Modality specific
- Negative in 60-70% of patients
- Hypo- to isointense areas of the brain compared to adjacent gray matter
- Variable, mostly hyperintense
- Homogeneous or nodular enhancement within the brain parenchyma
- Pachymeningeal or leptomeningeal enhancement
- Thickening of the pituitary gland, infundibulum or cranial nerves with associated enhancement
- Imaging Recommendations
- When parenchymal, mimics neoplasm and infection. When meningeal, classically will involve the basilar cisterns and can be difficult to differentiate from tuberculous meningitis or leptomeningeal tumor spread. More often, there is a combination of findings, including meningeal, cranial nerve and parenchymal involvement.
For more information, please see the corresponding chapter in Radiopaedia.
Contributor: Sean Dodson, MD
Christoforidis GA, et al. MR of CNS Sarcoidosis: Correlation of Imaging Features to Clinical Symptoms and Response to Treatment. AJNR. 199; 20:655-69.
Dumas JL, et al. Central Nervous System Sarcoidosis: Follow-up at MR Imaging during Steroid Therapy. Radiology. 2000; 214:411-20.
Ginat DT, et al. Magnetic Resonance Imaging of Neurosarcoidosis. J Clin Imaging Sci. 2011; 1:15
Smith JK, et al. Imaging Manifestations of Neurosarcoidosis. AJNR. 2004; 182:289-95.
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