Hydrocephalus as a presenting manifestation of neurosarcoidosis : easy to misdiagnose as tuberculosis

Abstract

We present a case of hydrocephalus as the primary manifestation of neurosarcoidosis. Sarcoidosis is a rare disease in Korea and its incidence is much lower than that of tuberculosis. Diagnosis is made by pathologic findings and by exclusion of other granulomatous disorders. Neurosarcoidosis is observed in approximately 5% of sarcoidosis. Its common manifestations are facial palsy (50% of patients with neurosarcoidosis) and optic neuritis. Hydrocephalus is a very uncommon reported finding. Although the typical presentation of sarcoidosis such as facial palsy is not a diagnostic dilemma, more atypical presentations such as hydrocephalus with altered mentality in a tuberculosis patient can lead to a misdiagnosis.

Keywords: Hydrocephalus; Neurosarcoidosis; Sarcoidosis; Tuberculosis.

Fig. 1

There are magnetic resonance images on admission. A : MRI image showed fourth ventricular mass and markedly dilated fourth ventricle. The mass in fourth ventricle enhanced by gadolinium. B : MRI image as axial cut at fourth ventricle showed leptomeningeal enhancement.

Fig. 2

Follow-up MR images obtained 15 days after the treatment show improved venriculomegaly and regression in size of the enhanced mass.