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Case Reports
. 2024 Feb 13;18(1):53.
doi: 10.1186/s13256-024-04359-9.

Corticosteroid treatment for acute hydrocephalus in neurosarcoidosis: a case report

Edoardo Dalmato Schilke  1   2 , Giulia Remoli  3   4 , Claudia Cutellé  3   4 , Claudia Balducci  3   4 , Diletta Cereda  3   4 , Maria Letizia Fusco  3   4 , Lucio Tremolizzo  3   4 , Carlo Ferrarese  3   4 , Ildebrando Appollonio  3   4 , Maura Frigo  3   4
Affiliations
Case Reports

Corticosteroid treatment for acute hydrocephalus in neurosarcoidosis: a case report

Edoardo Dalmato Schilke et al. J Med Case Rep. .

Abstract

Background: Neurosarcoidosis occurs symptomatically in 5-10% of patients with sarcoidosis, and hydrocephalus is a rare complication of neurosarcoidosis, with either acute or subacute onset and presenting symptoms related to increased intracranial pressure. It represents a potentially fatal manifestation with a mortality rate of 22% (increased to 75% in case of coexistence of seizures) that requires a prompt initiation of treatment. High-dose intravenous corticosteroid treatment and neurosurgical treatment must be considered in all cases of neurosarcoidosis hydrocephalus.

Case presentation: Here we present a case of hydrocephalus in neurosarcoidosis, complicated by generalized seizures, in a 29-year-old Caucasian male patient treated with medical treatment only, with optimal response.

Conclusion: Since neurosurgery treatment can lead to severe complications, this case report underlines the possibility to undergo only medical treatment in selected cases. Further studies are needed to stratify patients and better identify those eligible for only medical approach.

Keywords: Neuroimmunology; Neurosarcoidosis; Neurosurgery in sarcoidosis; Obstructive hydrocephalus.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Evidence of nodular contrast enhancement of the leptomeninges (a), optic nerves (b), white matter lesions (c), and cauda equina (d)
Fig. 2
Fig. 2
Main examinations performed after clinical worsening; brain MRI shows biventricular hydrocephalus and contrast enhancement of ependyma at the cerebral aqueduct (III and IV ventricles, a-c). Electroencephalogram shows intercritical epileptic discharges (d)
See this image and copyright information in PMC

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