Neurosarcoidosis Differential Diagnoses

Updated: Nov 13, 2018
  • Author: Gabriel Bucurescu, MD, MS, FACNS; Chief Editor: Tarakad S Ramachandran, MBBS, MBA, MPH, FAAN, FACP, FAHA, FRCP, FRCPC, FRS, LRCP, MRCP, MRCS  more...
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Diagnostic Considerations

Sarcoidosis in general can at times be notoriously difficult to diagnose. A delay in diagnosis can result in increased morbidity and, in rare occasions, death. Patients who develop a neurologic illness consistent with neurosarcoidosis but are not known to have sarcoidosis present a diagnostic challenge. Other causes of neuropathy need to be considered, depending on the type of neuropathy, including acquired causes such as toxin exposure, metabolic abnormalities, and inflammatory disorders.

Neurosarcoidosis should not be readily diagnosed in children. This disorder is not common in children, and care must be taken to exclude other pathologies before this diagnosis is made.

Although necrotizing sarcoidosis has been reported most commonly in the lungs and rarely in other organ systems, sarcoidosis and its necrotizing variant should be considered in the differential diagnosis of an agranulomatous mass lesion involving the CNS. This is particularly true in patients with a history of systemic disease.

Other problems to be considered in the differential diagnosis of neurosarcoidosis, depending on the presentation, include the following:

  • Brain tumors

  • Porphyria

  • Toxins such as alcohol and drugs (both therapeutic and recreational)

  • Neuropathies associated with monoclonal bands and paraproteinemias

  • Myopathy of all types

  • Carcinomatous and lymphomatous meningitis with resultant polyradiculopathy

  • Berylliosis

  • Vitamin B-12 deficiency

  • Paraneoplastic neuropathy

  • Paraproteinemic neuropathy

Differential Diagnoses