Neurosarcoidosis - Diagnosis and Treatment

 • 5 to 40% of sarcoidosis, Heterogeneous, often inaugural

 • Central Nervous System (85%): Aseptic meningitis, Intraparenchymatous lesion, Hypothalamus and pituitary gland, Myelitis, Cranial verves (II, V, VII), Cognitive disorders, Intracranial hypertension, Vasculitis

 • Peripheral Nervous System (15%):  Axonal or demyelinating neuropathy, Cranial nerves (ll, V, VII), Polyneuropathies, Multiple mononeuropathy, Polyradiculopathy, Muscles

Diagnosis of neurosarcoidosis: Clinical, CSF, Histology, MRI, Exclusion of Differential Diagnosis

Treatment ~ 2 years:

 • Non or paucisymptomatic: Oral glucocorticoids (GC) ± Hydroxychloroquine

 • Symptomatic: Pulses methylprednisolone 1g x 3-5 days then oral GC + immunosuppressants according to severity

 • Mild to moderate: Methotrexate 0.3 mg/kg/wk, Azathioprine 2-3 mg/kg/day, Mycophenolate 2-3 g/day

 • Severe:  Cyclophosphamide, TNF-a blockers: Infliximab 3-5 mg/kg W0, W2, W6 then every 4-6 weeks, or adalimumab



By Dr. Clara Fontenaille



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