CT demonstration of sarcoidosis of the optic nerve, frontal lobes, and Falx cerebri: Case report and literature review

The authors have reported a 39-year-old woman who developed headaches, recurrent seizures, hemiparesis, hemianesthesia, anosmia, and visual loss over a 2 1/2 years period. Diagnosis of sarcoidosis was established by histologic confirmation of a right frontal lobe granuloma and of two skin lesions. Multisystem disease was documented by abnormal chest films, gallium scan, and elevated serum immunoglobulins and prolactin. Serial CT scans over a 27 month period allowed them to see the evolution of neurosarcoidosis and to discover two CT features of this disease. To the CT findings already described in the literature as being highly suggestive of sarcoidosis, they would add the following: abnormal contrast uptake in an enlarged optic nerve and/or chiasm and dense nodular enhancement of a thickened, irregular falx. These additional abnormalities, as illustrated by their case, can be of considerable diagnostic aid since the presence of multiple abnormalities on CT adds specificity to the diagnosis of neurosarcoidosis.