Abstract Details

Title Clinicoradiographic Dissociation in Asymptomatic Bilateral Hippocampal Enhancement in Neurosarcoidosis

Topic Autoimmune Neurology

Presentation(s) P3 - Poster Session 3 (12:00 PM-1:00 PM)

Poster/Presentation
Number 091

Objective To describe a unique radiographic manifestation of neurosarcoidosis mimicking abnormalities found in limbic encephalitis.

Background Neurosarcoidosis is one of the great mimickers of modern clinical neurology and may involve any component of the nervous system, including the limbic system on rare occasion. Dissociation of radiographic abnormalities in asymptomatic patients is a described phenomenon in other forms of the disease.

Design/Methods Case report.

Results A 31-year-old man with a history of PTSD, depression, and insomnia presented with 2 weeks of progressive bilateral lower extremity weakness and numbness culminating in several falls. He denied bowel or bladder impairment, facial or arm involvement, or sensory symptoms. Cognition was noted to be slightly slowed, but otherwise no significant cognitive changes were noted. Examination demonstrated weakness and hyperreflexia of the bilateral lower extremities along with a T10 sensory level. Contrasted MRI of the brain demonstrated abnormal T2/FLAIR hyperintensities with associated patchy enhancement of the bilateral hippocampi, right greater than left. Contrasted MRI of the total spine demonstrated a longitudinally-extensive T2 hyperintensity of the cervicothoracic spinal cord extending from C2 to T11 with multifocal areas of nodular and linear enhancement. Cerebrospinal fluid was remarkable for lymphocytic pleocytosis and elevated protein. PET/CT revealed multiple metabolically-active mediastinal and hilar lymph nodes, with biopsy revealing non-caseating granulomas consistent with sarcoidosis. He was treated with intravenous methylprednisolone and plasma exchange with normalization of strength and persistently decreased sensation in the left leg on exam. Follow-up MRIs 3 months later demonstrated resolution of the enhancing hippocampal lesions.

Conclusions Neurosarcoidosis may present with radiographic findings that mimic limbic encephalitis in the absence of related clinical symptoms (seizures or changes in cognition or behavior), but a broad differential diagnosis and thorough work-up will often suggest the possibility of underlying sarcoidosis.

Authors/Disclosures
Gabriela A. Bou, MD (Emory University School of Medicine) PRESENTER	Dr. Bou has nothing to disclose.
Spencer Hutto, MD (Emory University: Neurology Residency Program)	Dr. Hutto has nothing to disclose.

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