Neurological manifestations of sarcoidosis

Abstract

Twenty-eight (3.5%) of 807 patients with sarcoidosis had neurological manifestations; 21 were women. Symptoms related to the central nervous system, with or without other symptoms, were the 1st manifestation of sarcoidosis in 20 patients. These included diabetes insip-idus, seizures, cranial nerve involvement, corticospinal tract signs, cerebellar deficit, and myopathy. With 1 exception, an abnormal thracic roentgenogram or a positive biopsy was found in every case in this group. Eighteen patients had cranial nerve involvement, most commonly of the facial nerve. Seven had corticospinal tract signs and 6 had cerebellar signs. Diabetes insipidus was present in 4, and 3 of these also had anterior pituitary failure. Five patients had seizures and 4 had a peripheral neuropathy. Two patients had a myopathy without other neurological symptoms. The combination of cranial nerve palsies with other neurological abnormalities occurred most often. The cerebrospinal fluid frequently showed a mild increase of protein andof cells but a normal sugar content. Two patients died, 7 were unchanged, 10 improved, 6 recovered, and 3 could not be traced. Steroid therapy is of equivocal efficacy in the treatment of central and peripheral nervous system and skeletal muscle sarcoidosis.