Objective: describe a 55-year-old man who developed a severe parkinsonism and epilepsy revealing a neurosarcoidosis

Background: movement disorders in demyelinating disease are uncommon and mainly coincidental. Parkinsonism has been previously reported in multiple sclerosis and lupus but rarely in neurosarcoidosis.

Method: case report

Results: A man in his mild fifties, with no medical history, manifested, since 2 years, with gait disorder and tremor of this right arm. On presentation, he had a right-dominant resting tremor and rigidity, severe bradykinesia and hypomimia. However, he had no cognitive impairment. He was treated with levodopa and piripedil with no good response. The follow-up showed a worsened parkinsonism with severe bradykinesia, depressive mood and tonic-clonic epileptic seizures. His Brain MRI revealed large areas of T2 weighted hyperintensities within the sub cortical and periventricular white matter in the right frontal, parietal, insular and temporal region. These lesions were enhanced after gadolinium injection. The CSF study showed no cells, a high protein level (1,11g/l) and normal glycorrachia. Otherwise, the patient developed progressive shortness of breath. His Chest CT scan revealed bilateral proximal pulmonary mass, along with multiple bilateral nodular lesions and bilateral mediastinal, sub clavicular and retro peritoneal adenopathy. The mass biopsy disclosed noncaseating tuberculoid granulomas and confirmed the diagnosis of sarcoidosis. The patient was treated with high dose of steroids associated with immunosuppressive therapy and showed, soon later, a significant improvement.

Conclusion: movement disorders especially parkinsonism is rarely revealing a neurosarcoidosis particularly with the absence of lesions within the basal ganglia. It is the presence of systemic manifestations, findings from CSF study and MRI that can lead to the proper diagnosis.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/a-severe-parkinsonism-revealing-neurosarcoidosis-a-case-report/