Aseptic meningitis and hydrocephalus secondary to neurosarcoidosis

A 53-year-old woman presented to hospital with gait instability, urinary incontinence and confusion. She had a 4-month history of headache, blurred vision, personality change and memory problems. Magnetic Resonance Imaging of the brain after contrast application showed tectal plate and occipital enhancement, as well as a known hydrocephalus. Cerebrospinal fluid showed aseptic meningitis with no evidence of clonal expansion. After further imaging that showed generalised lymphadenopathy and subsequent tissue biopsy that showed granulomatous lymphadenitis, she was diagnosed with neurosarcoidosis. She was treated with steroids which resulted in immediate cognitive and motor improvements as well as resolution of her urinary incontinence. We discuss the features of this case that pointed towards neoplastic, infective and other autoimmune aetiologies. We describe how they were excluded and provide the rationale for our treatment. This case demonstrates an important sequela sarcoidosis, and we conclude by recommending a multidisciplinary approach towards its diagnosis and management.