Neurosarcoidosis - Rare Presentation with Multiple Cranial Nerve Involvement

We report a rare case of neurosarcoidosis with multiple cranial nerve involvement in the absence of pulmonary features. It is estimated that less than 1 % of patients have an isolated CNS involvement, without systemic evidence of disease. A 42 year old man presented with symptoms of multiple cranial neuropathy. His MRI Brain showed abnormal enhancement in left trigeminal and facial nerve with bulky bilateral lacrimal glands. HRCT Thorax demonstrates perilymphatic nodules with patchy ground glass opacities and non-necrotic mediastinal lymphadenopathy. Patient underwent CT guided mediastinal lymph node biopsy which revealed non-caseating chronic granuloma, consistent with sarcoidosis.