Which physical findings are characteristic of 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

Clinical findings depend on the type and the nature of the peripheral nerve involvement. In diffuse polyneuropathy, patients experience weakness with a distal predominance. Deep tendon reflexes are attenuated or absent.

Sensory modalities are impaired in a stocking-and-glove distribution, with large-fiber modalities (eg, proprioception, vibration) more commonly and more severely affected than small-fiber functions (eg, pain, temperature). However, the prevalence of small-fiber neuropathy with pain as a symptom may be more frequent than previously recognized. Pure sensory neuropathy has been reported.

Myopathy is characterized by tenderness, muscles feeling "hard" on palpation, and weakness. Distal atrophy may be noted, depending on the duration of the neuropathy.

Focal neuropathies result in dysfunction in the distribution of that nerve. The most common of these neuropathies is that of unilateral lower motor neuron facial nerve, and patients often are thought to have Bell palsy at presentation. Facial nerve neuropathy also can be bilateral. [26]

Polyradiculopathy commonly affects the cauda equina. Patients present with asymmetrical weakness of the lower extremities, with loss of the deep tendon reflexes and patchy sensory loss, including the perianal region.

Eye involvement may be evident on examination; vision may be affected. Neurosarcoidosis may produce optic neuritis leading to optic atrophy. See the images below.

Atrophic right optic disc of a 37-year-old man wit Atrophic right optic disc of a 37-year-old man with neurosarcoidosis and involvement of both optic nerves. Vision was lost. The disc is pale with sharp borders.
Atrophic left optic disc of a 37-year-old patient Atrophic left optic disc of a 37-year-old patient with neurosarcoidosis and involvement of both optic nerves. The disc is pale with sharp borders. Vision was largely preserved.

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