MRI findings in Neurosarcoidosis Patients with Headache as a Primary Presenting Symptom

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Objective: To determine if there are MRI differences in patients with neurosarcoidosis, who present with headache as a primarily clinical symptom, compared with those who initially present with non-headache symptomatology. To the author’s knowledge, this has not been previously reported in the available literature.

Background: Neurologic complications occur in approximately 5 to 10 percent of patients with sarcoidosis. Clinical manifestations include cranial nerve palsies, sensory and/or motor deficits, and, commonly, persistent headache. The typical work-up of these patients includes a contrast enhanced brain MRI.

Design/Methods: This is an IRB-approved retrospective chart review conducted at an urban tertiary care center. 123 patients with Neurosarcoidosis were identified between the years 1980 and 2018, of whom 110 had a completed MRI at the time of diagnosis. These patients were then separated into two groups. Group A included patients who reported headache as their primary neurological complaint, while group B included patients whose presenting neurological symptom was other than headache. Available brain MRI reports were reviewed for each of these patients. Chi-square test was used for analysis.

Results: Out of the 110 patients, headache was an initial presenting symptom in 33 patients (Group A), of whom 24, or 73%, had meningeal contrast enhancement on their initial MRI. Of the 77 patients who presented initially with other than headache (Group B), 59, or 77%, did not have meningeal enhancement on their initial MRI (p-value <0.001).

Conclusions: Patients with neurosarcoidosis who present with headache as an initial symptom are more likely to have meningeal contrast enhancement as compared to those who present with other symptomatology. This suggests a clinicoradiologic link between headache and meningeal disruption in patients with neurosarcoidosis.





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