Neurosarcoidosis, clinical manifestations, diagnostic approach and therapeutic options

Abstract

Sarcoidosis is a chronic granulomatous disease mediated by the immune system, characterized by the histological presence of non-caseating granulomas, although its highest prevalence is pulmonary involvement, a percentage is at the level of the nervous system, this being a variable presentation over time. and with compromise of both brain parenchyma and its contained structures mainly hypothalamus and pituitary, central and peripheral cranial nerves, meninges and both arterial and venous blood vessels, with multiple clinical presentations ranging from neuropathic disorders, transverse myelitis, neuroendocrine dysfunction and myopathic conditions. . Although most of it is associated with another concomitant organic condition, a small percentage occurs as an isolated manifestation in its clinical presentation, many diagnostic methods are currently available to confirm or rule out this pathology, although the definitive diagnosis is made only by histological verification; There are already established clinical, imaging and laboratory criteria that allow the diagnostic approach to be carried out. Glucocorticoids are the cornerstone of treatment, especially in the acute stage, while steroid-sparing agents are of choice in prolonged therapy to minimize steroid toxicity, while biological agents can help in refractory or severe cases. box start. Neurosarcoidosis is a disease with devastating functional sequelae for the individual who presents it, but a more favorable functional outcome has been shown over time, possibly due to early recognition and aggressive therapy with glucocorticoids and immunosuppressants.