- Idiopathic systemic granulomatous disease with 5% of patients with sarcoidosis developing symptoms
- Approximately 10% of patients with sarcoidosis 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
- Depend on site of involvement
- Range from hydrocephalus, cranial nerve palsies, endocrinopathies, seizures, and paresthesias to myelopathy
- Most commonly presents in the third to fourth decade of life
- Female > male
- Most commonly afflicts African Americans
- Hydrocephalus and/or pachymeningeal, leptomeningeal, or parenchymal findings
- Modality specific
- Negative in 60% to 70% of patients
- Hypointense 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
- MRI with contrast
- When parenchymal, mimics neoplasm and infection, and 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, Spickler EM, Recio MV, et al. MR of CNS sarcoidosis: correlation of imaging features to clinical symptoms and response to treatment. AJNR Am J Neuroradiol 199;20:655–669.
Dumas JL, Valeyre D, Chapelon-Abric C, et al. Central nervous system sarcoidosis: follow-up at MR imaging during steroid therapy. Radiology 2000; 214:411–420. doi.org/10.1148/radiology.214.2.r00fe05411
Ginat DT, Dhillon G, Almast J. Magnetic resonance imaging of neurosarcoidosis. J Clin Imaging Sci 2011;1:15.
Smith JK, Matheus MG, Castillo M. Imaging manifestations of neurosarcoidosis. AJR Am J Roentgenol 2004;182:289–295. doi.org/10.2214/ajr.182.2.1820289
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