[Psychological and behavioral disorders with good outcome in neurosarcoidosis].
BACKGROUND
Neurological involvement is observed in 5% of cases of sarcoidosis and includes impairment of the central nervous system, the meninges, and the cranial and peripheral nerves. Besides neurological defects, cognitive impairment may be encountered ranging from isolated memory defect to dementia.


METHODS
We report a case of neurosarcoidosis occurring in a 40-year-old woman, a native of Reunion Island, with initial meningeal and hypophyseal involvement. Three years later, while treated with low dose prednisolone and methotrexate, she presented a paranoid state associated with cognitive impairment of frontal type and severe behavioral disturbances. After 2 years of high dose steroid treatment associated with hydroxychloroquine, her behavioral status improved, allowing social and familial reinsertion.


CONCLUSIONS
In our observation, sarcoidosis was revealed through a central neurological impairment, with chronic meningitis, facial nerve palsy, and, finally, through psychiatric symptoms and severe behavioral disturbances. A slow favorable outcome was obtained using high dose methylprednisolone and hydroxychloroquine with total regression of behavioral disturbances but with persisting cognitive alteration.
Service de médecine interne, hôpital de la Timone, 264, rue Saint-Pierre, 13385 Marseille, France.
B
B
Granel
C
C
Gaudy
J
J
Serratrice
C
C
de Roux-Serratrice
O
O
Félician
L
L
Swiader
X
X
Pache
M
M
Ceccaldi
M
M
Balzamo
A
A
Donnet
L
L
Manera
C
C
Raybaud
P
P
Disdier
P J
PJ
Weiller
D000328:Adult; D018501:Antirheumatic Agents / Q000627:therapeutic use; D003072:Cognition Disorders / Q000175:diagnosis / Q000209:etiology*; D004359:Drug Therapy, Combination; D005158:Facial Paralysis / Q000209:etiology*; D005260:Female; D006801:Humans; D006886:Hydroxychloroquine / Q000627:therapeutic use; D008279:Magnetic Resonance Imaging; D008581:Meningitis / Q000209:etiology*; D008727:Methotrexate / Q000627:therapeutic use; D009422:Nervous System Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D019965:Neurocognitive Disorders / Q000209:etiology*; D010259:Paranoid Disorders / Q000175:diagnosis / Q000209:etiology*; D011239:Prednisolone / Q000627:therapeutic use; D011379:Prognosis; D012507:Sarcoidosis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D016896:Treatment Outcome
D018501:Antirheumatic Agents; D006886:Hydroxychloroquine; D011239:Prednisolone; D008727:Methotrexate