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. 2025 Oct 20;13(10):e71106.
doi: 10.1002/ccr3.71106. eCollection 2025 Oct.

Hypothalamic Neurosarcoidosis With Multisystem Involvement: Case Report and Literature Review

Sajjad Ghanim Al-Badri  1 , Aditya Duhan  2 , Rania H Al-Taie  3 , Abbas Hamza Abbas  4 , Muntadher Yousif Hasan Al Gehadi  5 , Ibrahim Khalil  6 , Zaryab Bacha  7
Affiliations

Hypothalamic Neurosarcoidosis With Multisystem Involvement: Case Report and Literature Review

Sajjad Ghanim Al-Badri et al. Clin Case Rep. .

Abstract

Neurosarcoidosis with hypothalamic-pituitary involvement is rare and challenging to diagnose, requiring MRI and systemic clues for confirmation. High-dose corticosteroids are essential but often necessitate steroid-sparing agents due to side effects. Multidisciplinary care and vigilant follow-up are critical for managing persistent symptoms and preventing complications.

Keywords: corticosteroids; hypothalamic neurosarcoidosis; immunosuppression; sarcoidosis.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
MRI brain imaging obtained in October 2024, depicting hypothalamic involvement in neurosarcoidosis. (A) Axial FLAIR sequence showing band‐like hyperintensities along the periventricular and external capsule bilaterally, suggestive of inflammatory involvement. (B) Coronal T1‐weighted post‐contrast image demonstrating globular enhancement of the hypothalamus and proximal infundibulum. This enhancement extends toward the optic chiasm, consistent with active neurosarcoidosis. (C) Sagittal T1‐weighted post‐contrast image highlighting hypothalamic and infundibular enhancement, with additional involvement of the post‐chiasmatic optic tract, further supporting the diagnosis of neurosarcoidosis.
FIGURE 2
FIGURE 2
Axial post‐contrast T1‐weighted MRI images, highlighting hypothalamic and optic pathway involvement in neurosarcoidosis. (A) Axial post‐contrast T1‐weighted image demonstrating globular enhancement of the hypothalamus and proximal infundibular stalk, consistent with active inflammation. (B) Axial post‐contrast T1‐weighted image showing persistent enhancement of the right hypothalamus and adjacent optic chiasm, with no evidence of mass effect or midline shift. (C) Axial post‐contrast T1‐weighted image revealing subtle enhancement extending to the post‐chiasmatic optic tract, indicative of ongoing inflammatory involvement.
FIGURE 3
FIGURE 3
Multimodal imaging demonstrating multisystem sarcoidosis involvement. (A) Chest radiograph (posterior–anterior view) showing bilateral hilar lymphadenopathy and diffuse reticular opacities, consistent with pulmonary sarcoidosis. (B) Sagittal T1‐weighted MRI of the thoracic spine with gadolinium contrast showing patchy enhancement along the anterior thoracic spinal cord at the T4–T6 level, consistent with known spinal sarcoidosis. (C) Axial T1‐weighted post‐contrast MRI of the thorax showing extensive mediastinal lymphadenopathy with prominent enhancement, indicative of active systemic inflammation.
See this image and copyright information in PMC

References

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