Cerebral vasculitis related to neurosarcoidosis: a case series and systematic literature review

Abstract

Cerebral vasculitis is a rare but severe manifestation of neurosarcoidosis (NS) that has received little attention. The aim of the present study was to characterize clinical and diagnostic features as well as potential treatment strategies of cerebral vasculitis related to NS. We assessed 29 patients with cerebral vasculitis related to NS (15 female, mean age at time of diagnosis 45 years, SD = 11.85) among these were four new cases from our hospital records and 25 previously published cases from a systematic literature review. The demographic, clinical, and diagnostic features of those 29 patients with cerebral vasculitis related to NS were compared with a group of 73 NS patients without vasculitic involvement (37 female, mean age at time of diagnosis 47 years, SD = 14.79). Neurologic deficits and MRI abnormalities were significantly more frequent in cerebral vasculitis related to NS than in NS without vasculitic involvement. Patients with cerebral vasculitis related to NS significantly more often presented with headache, motor symptoms, and cognitive and/or behavioral changes. Non-neurologic manifestations of sarcoidosis did not significantly differ in character or frequency between both groups. Glucocorticoids in combination with methotrexate, cyclophosphamide, or infliximab were the most frequently used treatment strategies in cerebral vasculitis related to NS. Within the complex diagnostic work-up that is required in cerebral vasculitis related to NS sufficient angiographic imaging as digital subtraction angiography or MRI vessel wall imaging and tissue biopsy are of particular significance as they can detect vascular changes caused by inflammatory processes.

Keywords: Cerebral ischemia; Intracranial hemorrhage; Neurosarcoidosis; Sarcoidosis; Stroke; Vasculitis.

Fig. 1

Flow chart of the literature review process

Fig. 2

Neuroradiological characteristics of 4 patients with cerebral vasculitis related to neurosarcoidosis a MRI with leptomeningeal gadolinium enhancement in patient 1 from Table 5. b MRI with gliosis of brainstem in patient 1 from Table 5. c Angiogram with one microaneurysm of a pontine perforator artery in patient 1 from Table 5. d Angiogram with one microaneurysm of a pontine perforator artery in patient 4 from Table 5. e Angiogram with bilateral multiple caliber irregularities in patient 2 from Table 5. f Angiogram with moyamoya-like vasculitis in patient 3 from Table 5