INTRODUCTION: Sarcoidosis is a chronic, systemic, inflammatory disorder that is characterized by the formation of noncaseating granulomas. Patients may present with cranial nerve palsy, paresthesia, paresis, pyramidal signs, progressive cognitive decline, urinary retention, seizures, or hypothalamic-pituitary syndrome. Although the diagnosis of neurosarcoidosis can be challenging, neurological manifestations of sarcoidosis occur more frequently than previously described.

CASE REPORT: A 23-year-old African American man presented to our emergency department with diplopia, which was worsened on left horizontal gaze. On the day of admission, he had a witnessed seizure. Laboratory studies were significant only for mild leukopenia and erythrocyte sedimentation rate of 17 mm/h. Brain magnetic resonance imaging revealed diffuse thickening and enhancement of the dura, mild mass effect, and soft tissue enhancement through the foramen rotundum and left orbital apex. The patient was treated with intravenous methylprednisolone and discharged on 60 mg oral prednisone daily followed by a taper over a 2-month period.

CONCLUSIONS: Our case demonstrates that mild neurological deficits can be the initial presentation of neurosarcoidosis in patients with undiagnosed or proven sarcoidosis.