Case report: middle-aged woman from Ghana with unsteady gait and enlarging cerebellar mass

Abstract

Rationale: Neurosarcoidosis (NS) is an uncommon manifestation of systemic sarcoidosis, with a propensity for middle-agedwomen. Often discovered only at autopsy, rates of neurologic involvement (5%-10%) reported in the literature underscore a lack of sensitivity and specificity in current diagnostic methods.

Patient concerns: Herein, we describe a 53-year-old woman who presented with gait imbalance and distal extremity muscular weakness. She was known to harbor a brain mass (4 years in duration) that was monitored and recently seemed to enlarge.

Diagnosis: A subsequent brain biopsy showed necrotizing granulomatous inflammation suggestive of NS. However, no clinical or radiologic evidence of activity was found in other organs.

Interventions and outcomes: Ultimately, endo and transbronchial biopsies were performed, providing histologic confirmation of systemic sarcoidosis.

Lessons: This approach is advised in all instances of suspected NS where systemic involvement is in question.

Figure 1

MRI Brain: Heterogeneous hyperintense mass (coronal T2- and axial T2-weighted images) and iso-hypointense mass (sagittal T1-weighted image), with peripheral edema and narrowed, displaced fourth ventricle (dilated ventricles visible in sagittal T1-weighted image).

Figure 2

Brain Biopsy: Large non-necrotizing epithelioid granuloma and few giant cells in cerebellar tissue, consistent with sarcoidosis (H&E x 100).

Figure 3

FOB TBBX: Subepithelial bronchial tissue displaying well-formed granuloma of sarcoidosis; note giant cell inclusions (Schaumann bodies) and epithelioid cells (H&E x 400).