Parafalcine and bilateral convexity neurosarcoidosis mimicking meningioma: case report and review of the literature

Sarcoidosis is a granulomatous disorder of unknown origin that may rarely present solely as an intracranial tumor. Neurosarcoidosis can mimic more common disease processes, such as meningioma, glioma, or metastases. It is important to keep neurosarcoidosis in mind, both preoperatively and intraoperatively, to guide appropriate treatment. We present a case of neurosarcoidosis mimicking a parafalcine and bilateral convexity meningioma. A 44-year-old African-American woman was referred to our institution with a diagnosis of meningioma based on a 4-month history of headaches, decreased memory, personality changes, and decreased coordination and on the results of axial computed tomography, which revealed a parafalcine and bilateral convexity mass. Cerebral arteriography and magnetic resonance imaging were performed to better characterize the lesion for anticipated surgery. Despite corticosteroid therapy, the patient continued to have progressive symptoms and underwent surgery. Intraoperative frozen sections were consistent with neurosarcoidosis. The mass was then significantly debulked unilaterally. Laboratory studies and follow-up examinations revealed no evidence of systemic sarcoidosis. The patient received corticosteroid therapy and subsequently improved. Serial magnetic resonance imaging examinations during several months revealed decreasing tumor size.