12 - STROKE AND NEUROSARCOIDOSIS

Summary

This chapter investigates sarcoidosis-associated stroke syndromes. Sarcoidosis is often referred to as a "disease of exclusion". The definitive diagnosis of sarcoidosis requires histopathologic demonstration of noncaseating epithelioid granulomas that are not due to infection or malignancy. Patients can be classified as having possible, probable, or definite neurosarcoidosis based on the certainty of the diagnosis of multisystem sarcoidosis, the pattern of neurological disease, and the response to therapy. Corticosteroids are the mainstay of treatment for patients with symptomatic neurosarcoidosis; however, the severity and chronicity of this disease in some patients often leads to reluctance in subjecting patients to the long-term sequelae of corticosteroid treatment. Nonetheless, it is reasonable to decrease sarcoidosis-associated inflammation to decrease stroke risk. Anecdotal evidence suggests that concurrent use of corticosteroids and adjunctive agents is a reasonable approach. Antiplatelet agents has been used as a stroke-preventive strategy but have avoided thrombolytic interventions.