Cerebrovascular Manifestations of Neurosarcoidosis An Overview

Praveen Kesav,1 Anu Jacob,1 Syed Irteza Hussain,2 Seby John2 1Department of Neurology, Neurological Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates; 2Department of Neurology and Neurointerventional Surgery, Neurological Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab EmiratesCorrespondence: Seby John, Department of Neurology and Neurointerventional Surgery, Neurological Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, 112412, United Arab Emirates, Email JohnS5@ccad.aeAbstract: Neurosarcoidosis (NS) is defined as involvement of either central or peripheral nervous system by non-caseating granulomatous inflammation. They are seen clinically in 5– 10% of those with sarcoidosis, though sub-clinical involvement is commoner. Cerebrovascular manifestations of neurosarcoidosis (CVNS) are considered even rarer but availability of novel imaging techniques and awareness of potential imaging markers for NS (yet to be validated), has resulted in better recognition. CVNS can occasionally be the presenting manifestation of sarcoidosis. Despite being rare, those with CVNS may have higher morbidity and mortality compared to other forms of NS. In this review, we aim to describe the clinical features, approach to diagnosis, mimics, investigation and management of CVNS, while attempting to identify features that differentiate central nervous system vasculitis associated with NS (CNSV-NS) from primary central nervous system vasculitis (PCNSV), a close diagnostic mimic.Keywords: neurosarcoidosis, cerebrovascular neurosarcoidosis, vasculitis, stroke, NS