Imaging description

Evaluating a patient with multifocal neurologic symptoms is a diagnostic challenge for a neurologist [1]. Clinical symptomatology and imaging presentation of neurosarcoidosis is so diverse and varied, that it is one of the commonest differential diagnoses for a suitable case in board exams!

There is a wide spectrum of MR imaging findings in neurosarcoidosis. The spectrum of intracranial findings includes cranial nerve enhancement (Fig. 22.1), leptomeningeal enhancement (Fig. 22.2), and enhancing (Fig. 22.3) and non-enhancing parenchymal lesions [2]. Involvement of pituitary hypothalamic neuraxis (Fig. 22.4) is common, as is involvement of optic nerves (Fig. 22.4) [3]. Involvement of the brainstem (Fig. 22.5), the choroid plexus, and the ependymal lining of ventricular system (Fig. 22.5) can also be seen [4]. Involvement of the dura can lead to pachymeningeal thickening (Fig. 22.6) [5,6] and sometimes presence of dural-based extra-axial granulomatous mass that can mimic meningioma (Fig. 22.7). There can be intramedullary or extramedullary involvement of the spinal cord (Fig. 22.8) [7].