Neurosarcoidosis

• Alternative Names

  Sarcoidosis - nervous system

• Causes, incidence, and risk factors

  Sarcoidosis is a long-term (chronic) disorder that affects many parts of the body, mostly the lungs. In a small number of patients, the disease involves some part of the nervous system. This is called neurosarcoidosis.

  Neurosarcoidosis may affect any part of the nervous system. Sudden, facial weakness (facial palsy)is common and involves the nerves to the muscles of the face (cranial nerve VII). Any nerve in the skull can be affected, including those in the eye and those that control taste, smell, or hearing.

  The condition can also affect a part of the brain called the hypothalamus, which is involved in regulating many body functions such as temperature, sleep, and stress responses.

  Muscle weakness or sensory losses can occur with peripheral nerve involvement. Other areas of the brain, including the pituitary gland at the base of the brain, or the spinal cord may also be involved.

• Symptoms

  Involvement of the pituitary gland can cause:

  • Changes in menstrual periods
  • Excessive tiredness (fatigue)
  • Excessive thirst
  • High urine output

  Involvement of the brain or cranial nerves can cause:

  • Confusion, disorientation
  • Decreased hearing
  • Dementia or delirium
  • Dizziness or vertigo (abnormal sensation of movement)
  • Double vision or other vision problems
  • Facial palsy (weakness, drooping)
  • Headache
  • Loss of sense of smell
  • Loss of sense of taste, abnormal tastes
  • Psychiatric disturbances
  • Seizures
  • Speech impairment

  Involvement of one or more peripheral nerves:

  • Abnormal sensations in any body part
  • Loss of movement of any body part (joint stiffness)
  • Loss of sensation in any body part
  • Weakness of any body part

  Note: The symptoms vary. Any part of the nervous system can be affected.

• Signs and tests

  An exam may show problems with one or more nerves.

  A history of sarcoidosis followed nerve-related symptoms highly suggests neurosarcoidosis. However, symptoms of the condition can mimic other medical disorders, including diabetes insipidus, hypopituitarism, optic neuritis, meningitis, and certain tumors.

  Blood tests are not very helpful in diagnosing the condition. A lumbar puncture may show signs of inflammation. Increased levels of angiotensin-converting enzyme may be found in the blood or cerebrospinal fluid (CSF).

  MRI of the brain may be helpful. A chest x-ray often reveals signs of the sarcoidosis. Nerve biopsy of affected nerve tissue confirms the disorder.

• Treatment

  There is no known cure for the disorder. Treatment is indicated if symptoms are severe or progressive. The goal of treatment is to reduce symptoms.

  Corticosteroids such as prednisone are prescribed to reduce inflammation. They are often prescribed until symptom get better or go away. You may need to take the medicines for months, even years.

  Other medications, particularly those that suppress the immune system, may also be recommended.

  If you have numbness, weakness, vision or hearing problems, or other problems due to damage of the nerves in the brain, you may need physical therapy, braces, a cane, or walker.

  Psychiatric disorders or dementia may require medication for depression, safety interventions, and assistance with care.

  Pituitary disorders may respond to hormone replacement.

• Expectations (prognosis)

  Some cases go away on their own in 4-6 months. Other cases continue off and on for the rest of the person's life. Neurosarcoidosis can cause permanent disability and, in some cases, death.

• Complications

  Complications vary depending on which part of the nervous system is involved and how you respond to treatment. Slowly worsening or permanent loss of neurological function is possible. In rare cases, the brainstem may be involved. This is life threatening.

• Calling your health care provider

  Call your health care provider if you have sarcoidosis and any neurological symptoms occur.

  Go to the emergency room or call the local emergency number (such as 911) if you have a sudden loss of sensation, movement, or body function.

• Prevention

  Treatment of sarcoidosis turns off the body's faulty immune response before your nerves become damaged. This may reduce the chance that neurological symptoms will occur.

• References
  Lower EE, Weiss KL. Neurosarcoidosis. Clin Chest Med. 2008 Sep;29(3):475-92, ix. Review.

Review Date: 9/16/2008

Reviewed By: Daniel B. Hoch, PhD, MD, Assistant Professor of Neurology, Harvard Medical School, Department of Neurology, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.