# Diagnostic challenge in isolated Neurosarcoidosis: A case report

## TL;DR

This case report highlights the difficulty in diagnosing neuro-sarcoidosis when neurological symptoms alone are present, emphasizing the need for multidisciplinary evaluation.

## Contribution

The novelty lies in presenting a rare case of isolated neuro-sarcoidosis with unique MRI findings and diagnostic challenges.

## Key findings

- Neuro-sarcoidosis can manifest with neurological symptoms without extra-neural signs, complicating diagnosis.
- MRI findings such as T2 Flair hyperintensity and leptomeningeal enhancement are indicative of neuro-sarcoidosis.
- Peripheral nerve biopsy confirmed non-caseating granuloma, aiding in diagnosis despite mimicking other diseases.

## Abstract

Neuro-sarcoidosis is one of the uncommon manifestations of sarcoidosis that presents with diagnostic difficulties, particularly when the patient does not show any signs of extra-neural disease. We report an 18-year-old female with an initial manifestation of neck pain, vomiting, seizures and cranial nerves palsies. The first MRI showed the T2 Flair hyperintensity, cortical T1 hyperintensity, nodular leptomeningeal enhancement and small focus of restricted diffusion, which is an isolated finding in the neuro-sarcoidosis. Peripheral nerve biopsy showed the presence of a non-caseating granuloma. This case brings out the challenges of diagnosing neuro-sarcoidosis due to the diverse forms of neurological manifestation of the disease and its mimicry of other diseases such as multiple sclerosis. Sarcoidosis manifestations do not have strong systematic features, and hence, requires sophisticated clinical, radiological and CSF analysis for a provisional diagnosis. This case points to the diagnostic significance of neuro-sarcoidosis in patients developing the neurological manifestations, as well as the necessity for the multiple-disciplinary approach to the management of the disease.