Case 1:
46 year old man presented with headache, confusion, photophobia for five weeks with fever, night sweats and arthralgia. Patient saw Ophthalmologist for chronic Uveitis past one year without identified etiology. CT head, MRI brain unremarkable. MRV showed superior sagittal sinus thrombosis. Spinal fluid unremarkable. CT thorax revealed enlarged mediastinal, perihilar lymph nodes. Biopsy revealed granulomas confirming Sarcoidosis. Patient started on anticoagulant, steroids and immunosuppressant. Two months later, angiogram showed resolution of thrombosis with improved vision and no neurological deficits.
Case 2:
58 year old woman presented with two episodes of neurological events in six months: first episode with acute vertigo, unsteady gait, right sided hearing loss. She was treated as Multiple Sclerosis with high dose steroids and symptoms improved. Six months later, she experienced acute right hemiparesis. MRI revealed acute left cerebral infarct, multiple age-varied infarcts and leptomeningeal enhancement of bulbar structures. Pulmonary nodal biopsy showed non-necrotizing granuloma confirming Sarcoidosis. She was started on steroids. Despite treatment, patient developed two more strokes. Angiogram remarkable for vasculitis which was deemed etiology of recurrent strokes. In addition to Aspirin, Plavix and steroid, immunosuppression started with Mycophenolate with no further ischemic events.