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Presumptive isolated neurosarcoidosis involving eloquent structures: An argument for empirical TNF-α inhibition

      Highlights

      • The diagnosis of isolated neurosarcoidosis can be difficult.
      • Biopsy of eloquent neural structures carries a significant risk of morbidity.
      • There are clinical and radiological phenotypes characteristic of neurosarcoidosis.
      • Tumour-necrosis-factor-alpha inhibitor (TNF-I) is a potent therapeutic option.
      • In the appropriate clinical context, empirical TNF-I therapy can improve outcome.

      Abstract

      There are clinical and radiological phenotypes characteristic of neurosarcoidosis. Histopathologic confirmation is preferred, however, biopsy is associated with a significant risk of morbidity when only eloquent neural structures are involved and where there is no systemic disease. We present a series of patients with isolated neurosarcoidosis and suggest circumstances where an empirical, closely monitored, trial of tumour-necrosis-factor-alpha inhibitor therapy can improve outcome and diagnostic confidence.

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