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Case Reports: Reminder of important clinical lesson
Intracranial necrotising sarcoid granulomatosis mimicking petroclival meningioma
  1. Ashraf Valappil1,
  2. Shyam Sundar S2,
  3. Mishal Johny2 and
  4. Javed Ahamed TP3
  1. 1Neurology, Aster MIMS, Calicut, India
  2. 2Neurosurgery, Meitra Hospital, Calicut, India
  3. 3Neurology, Meitra Hospital, Calicut, India
  1. Correspondence to Dr Ashraf Valappil; drvvashraf{at}hotmail.com

Abstract

We present a unique case of biopsy-proven necrotising sarcoidosis involving the central nervous system in a man in his 40s. The patient presented with a 2-week history of right-sided headache and diplopia. He had right trochlear and abducens nerve palsy, sensory blunting over V1 and V2 segment of right trigeminal sensory nerve and right sensory neural hearing loss. A contrast-enhanced MRI revealed an enhancing dural-based mass lesion in the petroclival area suggestive of probable meningioma. Surgical resection was attempted and intraoperative consultation with frozen section revealed granulomata. So, the lesion was biopsied and surgical intervention was terminated. A diagnosis of necrotising neurosarcoidosis was confirmed on histopathology. He was treated with steroids after excluding other causes of intracranial necrotising granulomas like tuberculosis and he clinically responded favourably. We report one of the very few case reports of histologically proven necrotising sarcoidosis involving the central nervous system mimicking petroclival meningioma.

  • Neuroimaging
  • Cranial nerves

https://doi.org/10.1136/bcr-2021-247792

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    Footnotes

    • Contributors AV treated and followed up the patient and prepared the draft manuscript. SSS did the surgical procedure and did the editing of manuscript. MJ did the surgical procedure. JATP did the final editing 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.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

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