Neurosarcoidosis: symptoms, diagnosis, and treatment – current state of knowledge

Neurosarcoidosis is an inflammatory disease of unknown aetiology, characterised by the presence of non-caseating granulomas within the nervous system. Its prevalence in patients diagnosed with sarcoidosis is estimated to be approximately 10%. The clinical presentation is ambiguous, with symptoms that may manifest acutely or progress gradually over time. Many of these symptoms mimic those of other diseases, making neurosarcoidosis a diagnostic challenge. No sufficiently sensitive or specific biomarkers are available to enable an accurate diagnosis. A range of diagnostic tests must be performed to exclude other conditions. Histopathological confirmation via biopsy is necessary to make a definitive diagnosis, which is not always possible due to the location of lesions and the potential risk of complications associated with performing a biopsy. Once a diagnosis is established, regular follow-up examinations are necessary to monitor disease activity and assess the progression of changes. The optimal treatment strategy depends on the patient’s current clinical status and the potential risk of side effects. Three main lines of treatment for neurosarcoidosis have been described. Treatment selection should also take into account the ability of medications to cross the blood–brain barrier. Treatment response, severity of the disease at the time of diagnosis, and lesion location within the nervous system all influence the prognosis. With appropriate treatment, the majority of patients achieve either complete or partial remission. Therefore, neurosarcoidosis requires multidisciplinary specialist care and a comprehensive approach to each patient.