1. Oregon Health and Science University
Bilateral Lymphadenopathy and Strokes from Granulomatous Cerebral Angiitis: Case Report and A Literature Review
Sujani Bandela, MD; Michael Lane, MD; Hormozd Bozorgchami, MD
Oregon Health and Science University
Introduction: Neurosarcoidosis can result in granulomatous inflammation in the blood vessels in the cerebrum, but strokes are still less common in this disease process. The possible mechanisms can be from direct invasion of arterioles that can result in granulomatous inflammation, from a cardioembolic phenomenon or from large vessel inflammation. The inflammation can result in stenosis of the cerebral vessels resulting in a lacunar infarct but can also result in larger strokes. We present a case of a 50-year-old male patient who presented for encephalopathy, gait disturbances, and dysarthria and was found to have multiple large foci of strokes from diffuse angiitis from probable neurosarcoidosis that was identified on cerebral angiogram.
Methods: A literature review of neurosarcoidosis, the vascular manifestations, and patient encounter and chart review.
Results: A 50-year-old man with biopsy-proven pulmonary sarcoidosis was admitted and was found to have acute strokes on MRI. Given his history of extracranial sarcoidosis, the patient had another MRI with contrast to investigate the etiology of the strokes as neurosarcoidosis was at the top of the differentials. The MRI showed multiple enhancing nodular foci surrounding the bilateral middle cerebral arteries concerning for neurosarcoidosis, and a cerebral angiogram was pursued for better characterization of cerebral arteries, which demonstrated many intracranial vascular irregularities including a internal carotid artery stenosis and some distal vessels consistent with sarcoid related angiitis. Chronic immunosuppression was initiated, and the patient had significant improvement.
Conclusions: The cerebral angiogram was diagnostic in determining the etiology of these strokes being from diffuse vasculitis from probable neurosarcoidosis. Neurological complications are seen in about 5-10 percent of sarcoid patients with manifestations of facial nerve palsy is seen in 25 percent of individuals, but strokes are very rare. Neurosarcoidosis with diffuse angiitis and nodular enhancement near the bilateral middle cerebral arteries are less seen in literature.
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