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Hydrocephalus as the first presenting symptom of neurosarcoidosis in two patients: a diagnosis more forthcoming in the context of systemic disease
  1. Anna McKeever1,
  2. Amanda Cox1,
  3. Matthew Garnett2 and
  4. Nicholas G Cunniffe3
  1. 1 University of Cambridge, Cambridge, UK
  2. 2 Division of Neurosurgery, University of Cambridge, Cambridge, UK
  3. 3 Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
  1. Correspondence to Anna McKeever, am2311{at}


Sarcoidosis is a multisystem disorder, characterised histologically by the presence of non-caseating epithelioid granulomas with exclusion of other granulomatous diseases. While the lungs and lymph nodes are affected in 90%, approximately 5% of patients have neurological involvement. The clinical manifestations of neurosarcoidosis (NS) are diverse, making diagnosis especially difficult in patients without known systemic disease. Hydrocephalus occurs in only 9% of patients with NS and although uncommon, is an important manifestation because it is associated with high morbidity and mortality. We report two cases of NS presenting with hydrocephalus, one as the first presentation of sarcoidosis and one in a patient with known multisystem sarcoidosis. The patient without systemic sarcoidosis posed the greater diagnostic challenge and followed a protracted course with multiple surgical interventions, progression of central nervous system inflammation and significant physical disability.

  • hydrocephalus
  • neurology
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  • Contributors AMK: data collection and drafted manuscript. AC: revision of manuscript. MG: revision of manuscript. NGC: data collection and revision of manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.

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