DOI: 10.36347/sjams.2021.v09i05.023

Pages: 743-745

Sarcoidosis is a systemic granulomatosis characterized by predominantly mediastinopulmonary involvement. Neurological involvement is reported in 5-16% of cases with predominant involvement of the central nervous system. The pseudotumoral form is only reported in 10% of neurological forms, and poses a real diagnostic problem, as is the case with our present observation. Observation: 77-year-old patient hospitalized for treatment of right hemiparesis with aphasia. In his ATCDs, we retain a follow-up for an undetermined psychiatric condition. The onset of the disease dates back 5 months after his hospitalization with the sudden onset of right hemiplegia accompanied by generalized tonicoclonic convulsive seizures, with secondary recovery of the motor deficit and the onset of extra-pyramidal syndrome. Imaging finds the presence of several cerebral lesional processes and at the thoracic level, nodular lesions especially of the 2 upper lobes without mediastinal lymphadenopathy. The laboratory results were normal apart from an inflammatory syndrome and lymphopenia. Stereotaxic biopsy showed chronic inflammatory changes with ischemic necrosis without tumor lesions. Discussion: Pseudotumoral neurosarcoidosis is rare and difficult to diagnose, especially in the absence of characteristic extra neurological involvement. The histological study can find 2 aspects: classic granuloma or rarely lesions of ischemic necrosis. Treatment is based on glucorticoids and in case of resistance, intolerance or dependence, immunosuppressants (methotrexate, cyclophosphamide).