How is neuropathy characterized in neurosarcoidosis?

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

Most of the neuropathies associated with sarcoidosis are initially multifocal and eventually become confluent; thus, the initial presentation may be that of mononeuritis multiplex. This is seen most frequently in the cranial nerves: lower motor neuron neuropathy of the facial nerve (the nerve most frequently involved) may present along with other cranial neuropathies or as bilateral facial neuropathies, sometimes in a sequential manner mimicking Lyme disease.

When neuropathy is associated with fever, uveitis, and parotid gland enlargement, some patients may be thought to have Heerfordt syndrome. [9] Carpal tunnel syndrome may be more common in patients with sarcoidosis than in the general population. [10, 11, 12] Audiovestibular manifestations of sarcoidosis (especially sensory hearing loss) are likely to be primarily a result of vestibulocochlear nerve neuropathy. [13]

In a series of 57 patients with biopsy-proven sarcoidosis causing limb neuropathy, most patients noted a definite date of clinical onset. Positive neuropathic sensory symptoms—especially pain—were prominent, overshadowing weakness and sensory loss. The pattern was almost always asymmetric and not length-dependent (unlike distal polyneuropathy). The pathologic process was focal or multifocal, involving most classes of nerve fibers and variable levels of proximal to distal levels of roots and peripheral nerves. [14]

A case of neurosarcoidosis presenting as complicated sinusitis has been reported, but the incidence of sinonasal cases is rare, ranging from 1-4% of patients. Head and neck manifestations occur in approximately 10-15% of patients with sarcoid. [15]


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