Relapsing encephalopathy with headache: an unusual presentation of isolated intracranial neurosarcoidosis

After cranial neuropathy, headache is the most common manifestation of neurosarcoidosis, affecting an estimated 30% of patients. 2 There is no typical headache although reports suggest leptomeningeal inflammation is often associated with diffuse or bifrontal pain, and may be associated with papilloedema, as noted in this case. 3 CSF analysis can be helpful when a pattern of mild pleocytosis, high protein content and, sometimes, reduced glucose is seen. [...]CSF abnormalities are not specific to the disease, may be evanescent and in more than a third of cases patients have a normal CSF. 1 Cranial MRI is the most valuable investigative tool with CNS lesions present in 80-90% of affected patients. 4 In our case the MRI findings suggestive of leptomeningeal inflammation were made 3 years after the first admission, following previously normal cranial magnetic resonance imaging studies.