[Boeck's sarcoid of the central nervous system. 5 personal observations]

Sarcoidosis presenting with diabetes insipidus followed by acute cranial nerve syndrome. A case report

Diabetes insipidus in a previously healthy 16-year-old girl led to surgical exploration of a pituitary stalk intumescence detected by oxygen cisternography with the use of tomography. Biopsy of the pituitary stalk contained chronically inflamed brain tissue. Subsequent liver and bone biopsies showed characteristic granulomata, confirming the diagnosis of sarcoidosis. Subfrontal craniotomy was followed by a rapidly progressive basal meningoencephalitis with multiple cranial nerve involvement. The need to establish a causal diagnosis in diabetes insipidus is stressed. The rarity of the disorder and the presumed role of subfrontal craniotomy with regard to the flare-up of the sarcoidosis of the brain are discussed.

Solitary spinal cord sarcoidosis without other manifestations of systemic sarcoidosis

We report a biopsy-proven case of sarcoidosis limited to the spinal cord and responsive to treatment with oral corticosteroids. Involvement of the spinal cord by systemic sarcoidosis is uncommon and is associated with several unusual pathological and radiological characteristics that may contribute to its misdiagnosis and subsequent mismanagement. The importance of these unusual characteristics is greatly amplified in solitary spinal cord sarcoidosis because there are no systemic findings to suggest a sarcoid etiology.

Subacute myelopathy as the presenting manifestation of sarcoidosis

We studied a patient with progressive myelopathy, in whom systemic sarcoidosis was discovered. Involvement of other organs was asymptomatic. The myelopathy considerably improved after corticosteroid therapy. Spinal cord involvement in sarcoidosis is very uncommon, and its occurrence as a presenting manifestation is even rarer. Prompt recognition is emphasized, because it is a treatable condition.

Radiological findings in neurosarcoidosis

The radiological investigation of neurosarcoidosis is discussed in relation to a series of 32 patients presenting to a neurological hospital. Cranial computed axial tomography, performed in 13 of these cases, was the most frequently positive procedure (77%). The indications for air studies are now limited but in cases with nerve or chiasmal syndromes and negative CAT they may show small mass lesions, or incomplete filling of basal cisterns due to granulomatous infiltration or fibrosis. Sarcoid masses are avascular and angiography is only useful for exclusion of incidental tumours with pathological circulation. Cord syndromes were present in eight cases, but myelography was only indicated in five of these and was normal in three. The cord may be involved by intra-medullary granulomas or meningeal infiltration causing arachnoiditis, both of which cause myelographic abnormalities though these are not specific for sarcoidosis.