Background: Neurosarcoidosis manifests symptomatically in 5% of patients with sarcoidosis
and diagnosis can be challenging if not clinically suspected. Cerebral mass-like presentation
of neurosarcoidosis rarely reported in the literature. We presented a woman with neurosarcoidosis
who had a cerebral mass-like lesion which completely disappeared after medical treatment.
Discussion: A 37-year-old woman with history of pulmonary sarcoidosis referred to the emergency
service of our hospital with a one-month history of progressive dizziness, nausea and seeing
flashing lights. At neurologic examination, numbness and weakness on the left side of the body, deviation
of uvula toward the right side was seen. Cranial MRI demonstrated a 2.5x2 cm in size mass
lesion which hypointense on T1 WI, heterogeneous hyperintense on T2 and FLAIR sequence with
peripheral vasogenic edema and heterogeneous, irregular contrast enhancement simulating brain tumor.
Also, leptomeningeal and nodular contrast enhancement was seen on brainstem, cerebellar
vermis, perimesencephalic cistern and left frontal, bilateral parietooccipital sulcus. In laboratory
tests; The level of serum angiotensin-converting enzyme (ACE) was 53 IU/mL (N:8-52 IU/mL)
and cerebrospinal fluid (CSF) ACE was 23 IU/mL (N:0-2.6 IU/mL). CSF cytology analysis was
normal. Pattern 2 oligoclonal bands were present. With these clinical, laboratory and radiological
findings, cerebral involvement of sarcoidosis was suspected. Biopsy was not performed due to the
high risk of morbidity caused by the deep location of the lesion.Patient was treated with methylprednisolone
and Azathioprine for a month.On post-treatment control imaging; lesion disappeared
completely without residual leptomeningeal and nodular contrast enhancement.Also, neurologic
symptoms were decreased remarkably.
Conclusion: Multi-system inflammatory disorders like sarcoidosis, can present with mass-like lesion
in the brain parenchyma. While early diagnosis is important to prevent unnecessary interventions
like biopsy and surgery, it is crucial to initiate the necessary treatment with the aim of recovery
without sequelae. Radiological and clinical follow-up are fundamental in differential diagnosis.