{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T17:35:59Z","timestamp":1782236159383,"version":"3.54.5"},"reference-count":38,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2023,12,31]],"date-time":"2023-12-31T00:00:00Z","timestamp":1703980800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Sarcoidosis is a chronic granulomatous disease of unknown cause characterized by the presence of non-caseating granulomas. The disease can affect any organ including the nervous system. Neurosarcoidosis occurs in about 5% patients with sarcoidosis. The clinical presentation of neurosarcoidosis is varied, and it can involve the brain, spinal cord and peripheral nervous system, separately or in different combinations. The diagnosis of neurosarcoidosis is challenging, as biopsies from the nervous system are not readily available. Anti-TNF\u03b1 agents are becoming one of the cornerstone treatments for neurosarcoidosis. In this case-based review, we discuss two cases of neurosarcoidosis with different clinical presentations. The first patient presented with confusion, while the second presented with walking difficulty and neurogenic bladder. Both patients were treated with methylprednisolone pulse therapy with rapid, but non-complete, improvement. Therefore, infliximab was initiated in both cases with subsequent improvement in the clinical manifestations and imaging findings, emphasizing the effectiveness and safety of infliximab in cases of severe neurosarcoidosis. In conclusion, the goal of neurosarcoidosis management is to prevent organ system damage and minimize the toxic cumulative adverse effects of glucocorticoid use. In this case-based review we discuss the various presentations, the diagnosis and the treatment of neurosarcoidosis.<\/jats:p>","DOI":"10.3390\/life14010069","type":"journal-article","created":{"date-parts":[[2023,12,31]],"date-time":"2023-12-31T06:37:12Z","timestamp":1704004632000},"page":"69","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Neurosarcoidosis: The Presentation, Diagnosis and Treatment Review of Two Cases"],"prefix":"10.3390","volume":"14","author":[{"given":"Maamoun","family":"Basheer","sequence":"first","affiliation":[{"name":"Internal Medicine Department, Galilee Medical Center, Nahariya 221001, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hamd","family":"Waked","sequence":"additional","affiliation":[{"name":"Neurology Department, Galilee Medical Center, Nahariya 221001, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8624-6332","authenticated-orcid":false,"given":"Helana","family":"Jeries","sequence":"additional","affiliation":[{"name":"Rheumatology Unit, Galilee Medical Center, Nahariya 221001, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olga","family":"Azrilin","sequence":"additional","affiliation":[{"name":"Neurology Department, Galilee Medical Center, Nahariya 221001, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dan","family":"Paz","sequence":"additional","affiliation":[{"name":"Radiology Department, Galilee Medical Center, Nahariya 221001, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2279-6041","authenticated-orcid":false,"given":"Nimer","family":"Assy","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, Galilee Medical Center, Nahariya 221001, Israel"},{"name":"The Azrieli Faculty of Medicine, Bar-Ilan University, Safed 1311502, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9777-2864","authenticated-orcid":false,"given":"Mohammad E.","family":"Naffaa","sequence":"additional","affiliation":[{"name":"Radiology Department, Galilee Medical Center, Nahariya 221001, Israel"},{"name":"The Azrieli Faculty of Medicine, Bar-Ilan University, Safed 1311502, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3305-6054","authenticated-orcid":false,"given":"Samih","family":"Badarny","sequence":"additional","affiliation":[{"name":"Neurology Department, Galilee Medical Center, Nahariya 221001, Israel"},{"name":"The Azrieli Faculty of Medicine, Bar-Ilan University, Safed 1311502, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,12,31]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1155","DOI":"10.1016\/S0140-6736(13)60680-7","article-title":"Sarcoidosis","volume":"383","author":"Valeyre","year":"2014","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"727","DOI":"10.1016\/j.ccm.2015.08.013","article-title":"Consequences of sarcoidosis","volume":"36","author":"Drent","year":"2015","journal-title":"Clin. Chest Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1885","DOI":"10.1164\/ajrccm.164.10.2104046","article-title":"Clinical characteristics of patients in a case control study of sarcoidosis","volume":"164","author":"Baughman","year":"2001","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1007\/s11926-022-01089-z","article-title":"Neurosarcoidosis: Phenotypes, Approach to Diagnosis and Treatment","volume":"24","author":"Gosselin","year":"2022","journal-title":"Curr. Rheumatol. Rep."},{"key":"ref_5","first-page":"159","article-title":"The mode of presentation of sarcoidosis in Finland and Hokkaido, Japan. A comparative analysis of 571 Finnish and 686 Japanese patients","volume":"13","author":"Pietinalho","year":"1996","journal-title":"Sarcoidosis Vasc. Diffuse Lung Dis."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1097\/MCP.0000000000000401","article-title":"Many faces of neurosarcoidosis: From chronic meningitis to myelopathy","volume":"23","author":"Fritz","year":"2017","journal-title":"Curr. Opin. Pulm. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1546","DOI":"10.1001\/jamaneurol.2018.2295","article-title":"Definition and Consensus Diagnostic Criteria for NeurosarcoidosisFrom the Neurosarcoidosis Consortium Consensus Group","volume":"75","author":"Stern","year":"2018","journal-title":"JAMA Neurol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1906","DOI":"10.1007\/s00415-018-8928-2","article-title":"Sarcoidosis of the central nervous system: Clinical features, imaging and CSF results","volume":"265","author":"Kidd","year":"2018","journal-title":"J. Neurol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e270","DOI":"10.1212\/NXI.0000000000000270","article-title":"Optic neuropathy associated with systemic sarcoidosis","volume":"3","author":"Kidd","year":"2016","journal-title":"Neurol. Neuroimmunol. Neuroinflamm."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1080\/08820530802007382","article-title":"Neuro-Ophthalmic sarcoidosis: The University of Iowa experience","volume":"Volume 23","author":"Koczman","year":"2008","journal-title":"Seminars in Ophthalmology"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1093\/brain\/awf027","article-title":"Nerve granulomas and vasculitis in sarcoid peripheral neuropathy: A clinico pathological study of 11 patients","volume":"125","author":"Said","year":"2002","journal-title":"Brain"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1016\/j.jns.2006.01.014","article-title":"The natural history and long-term outcome of 57 limb sarcoidosis neuropathy cases","volume":"244","author":"Burns","year":"2006","journal-title":"J. Neurol. Sci."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1016\/B978-0-444-52902-2.00027-8","article-title":"Sarcoidosis of the peripheral nervous system","volume":"115","author":"Said","year":"2013","journal-title":"Handb. Clin. Neurol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1558","DOI":"10.1212\/WNL.41.10.1558","article-title":"Sarcoid peripheral neuropathy","volume":"41","author":"Zuniga","year":"1991","journal-title":"Neurology"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"981","DOI":"10.1093\/qjmed\/hcs121","article-title":"Hypothalamo-Pituitary sarcoidosis: A multicenter study of 24 patients","volume":"105","author":"Langrand","year":"2012","journal-title":"QJM"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1007\/s11102-015-0678-x","article-title":"Hypothalamic\u2013pituitary sarcoidosis with vision loss and hypopituitarism: Case series and literature review","volume":"19","author":"Anthony","year":"2016","journal-title":"Pituitary"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e26","DOI":"10.1164\/rccm.202002-0251ST","article-title":"Diagnosis and detection of sarcoidosis. An official American Thoracic Society Clinical Practice Guideline","volume":"201","author":"Crouser","year":"2020","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2004079","DOI":"10.1183\/13993003.04079-2020","article-title":"ERS clinical practice guidelines on treatment of sarcoidosis","volume":"58","author":"Baughman","year":"2021","journal-title":"Eur. Respir. J."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Meyer, J.S., Foley, J.M., and Campagna-Pinto, D. (1952). Granulomatous angiitis of the meninges in sarcoidosis. Arch. Neurol. Psych., 587\u2013600.","DOI":"10.1001\/archneurpsyc.1953.02320290039005"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1274","DOI":"10.1111\/ene.13975","article-title":"The cerebrospinal fluid CD4\/CD8 ratio and interleukin-6 and -10 levels in neurosarcoidosis: A multicenter, pragmatic, comparative study","volume":"26","author":"Chazal","year":"2019","journal-title":"Eur. J. Neurol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1001\/archneur.64.5.691","article-title":"Aggressive therapy for neurosarcoidosis: Long-term follow-up of 48 treated patients","volume":"64","author":"Scott","year":"2007","journal-title":"Arch. Neurol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e1084","DOI":"10.1212\/NXI.0000000000001084","article-title":"Neurosarcoidosis Pathophysiology, Diagnosis, and Treatment. Neurology: Neuroimmunology & Neuroinflammation","volume":"8","author":"Bradshaw","year":"2021","journal-title":"Neurol. Neuroimmunol. Neuroinflamm."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Fritz, D., van de Beek, D., and Brouwer, M.C. (2016). Clinical features, treatment and outcome in neurosarcoidosis: Systematic review and meta-analysis. BMC Neurol., 16.","DOI":"10.1186\/s12883-016-0741-x"},{"key":"ref_24","first-page":"118","article-title":"A prospective study of 32 patients with neurosarcoidosis","volume":"20","author":"Allen","year":"2003","journal-title":"Sarcoidosis Vasc. Diffuse Lung Dis."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1517\/14740338.2015.1009036","article-title":"Infection risk associated with anti-TNF-\u03b1 agents: A review","volume":"14","author":"Murdaca","year":"2015","journal-title":"Expert Opin. Drug Saf."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"488","DOI":"10.1007\/s00415-005-0043-5","article-title":"Neurosarcoidosis. Clinical description of 7 cases with a proposal for a new diagnostic strategy","volume":"253","author":"Marangoni","year":"2006","journal-title":"J. Neurol."},{"key":"ref_27","first-page":"943","article-title":"Neurosarcoidosis. A report of 5 cases","volume":"67","author":"Elkin","year":"1985","journal-title":"S. Afr. Med. J."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1164\/rccm.200603-402OC","article-title":"Infliximab therapy in patients with chronic sarcoidosis and pulmonary involvement","volume":"174","author":"Baughman","year":"2006","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"2092","DOI":"10.1212\/WNL.0000000000004644","article-title":"Infliximab for the treatment of CNS sarcoidosis: A multi-institutional series","volume":"89","author":"Gelfand","year":"2017","journal-title":"Neurology"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"2064","DOI":"10.1007\/s00415-021-10793-2","article-title":"Adalimumab for CNS sarcoidosis: Single-center experience and literature review","volume":"269","author":"Hutto","year":"2022","journal-title":"J. Neurol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1093\/qjmed\/hct023","article-title":"Radiological remission and recovery of thirst appreciation after infliximab therapy in adipsic diabetes insipidus secondary to neurosarcoidosis","volume":"108","author":"Sexton","year":"2015","journal-title":"QJM"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"11795735231195756","DOI":"10.1177\/11795735231195756","article-title":"Disseminated Aspergillosis in a Patient with Neurosarcoidosis: Persistent Contrast Enhancement in CNS Despite Prolonged Antifungal Treatment: A Case Report","volume":"15","author":"Shirani","year":"2023","journal-title":"J. Cent. Nerv. Syst. Dis."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"891","DOI":"10.1007\/s00415-017-8444-9","article-title":"Long-term outcomes of refractory neurosarcoidosis treated with infliximab","volume":"264","author":"Bouvry","year":"2017","journal-title":"J. Neurol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1073","DOI":"10.1007\/s00415-019-09234-y","article-title":"Infliximab biosimilar for treating neurosarcoidosis: Tolerance and efficacy in a retrospective study including switch from the originator and initiation of treatment","volume":"266","author":"Riller","year":"2019","journal-title":"J. Neurol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1097\/WNF.0000000000000047","article-title":"Overnight Response to Infliximab in Neurosarcoidosis: A Case Report and Review of Infliximab Treatment Practice","volume":"37","author":"Lorentzen","year":"2014","journal-title":"Clin. Neuropharmacol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"e847","DOI":"10.1212\/NXI.0000000000000847","article-title":"Infliximab treatment in pathology-confirmed neurosarcoidosis","volume":"7","author":"Fritz","year":"2020","journal-title":"Neurol. Neuroimmunol. Neuroinflamm."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"23247096211012191","DOI":"10.1177\/23247096211012191","article-title":"Pituitary Sarcoidosis in a Pediatric Patient Successfully Treated with Adalimumab and Methotrexate","volume":"9","author":"Thakral","year":"2021","journal-title":"J. Investig. Med. High. Impact Case Rep."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1111\/1756-185X.12122","article-title":"Neurosarcoidosis mimicking multiple sclerosis successfully treated with azate and adalimumab","volume":"17","author":"Metyas","year":"2014","journal-title":"Int. J. Rheum. Dis."}],"container-title":["Life"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-1729\/14\/1\/69\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:45:06Z","timestamp":1760132706000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-1729\/14\/1\/69"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,12,31]]},"references-count":38,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,1]]}},"alternative-id":["life14010069"],"URL":"https:\/\/doi.org\/10.3390\/life14010069","relation":{},"ISSN":["2075-1729"],"issn-type":[{"value":"2075-1729","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,12,31]]}}}