A Case of Neurosarcoid Presenting as Multiple Intraparenchymal Hemorrhages

Amit Mehta, Fahad Khan, Chris Wagner, Taymour Hashemzadeh, Andrew Stemer, Emily A. Sloan, Douglas Mayson, Faria Amjad

Research output: Contribution to journalArticlepeer-review


This report explores the case of a 49-year-old African American male with a six-month history of multifocal neurological deficits who presented to an outside hospital after a generalized seizure. Patient was transferred to our tertiary medical center after brain imaging showed multiple bilateral supratentorial intraparenchymal hemorrhages (IPH). A brain biopsy confirmed parenchymal and perivascular non-caseating granulomas with vasculitis. The patient was definitively diagnosed with neurosarcoidosis (NS) and his condition improved with high dose corticosteroids and additional immunosuppressive therapies. Intracranial hemorrhage in the setting of NS is extremely rare, with fewer than thirty documented cases; however, this is likely an underestimation of its true prevalence. This case illustrates the difficulty in diagnosis as many other etiologies of IPH must be considered. Additionally, the clinical course and manifestations of NS is often quite variable. The uniqueness of this case lies in the rapid progression from seemingly incidental microhemorrhages to multiple large IPHs over two months. While the cause of this progression is not immediately apparent, a possible cause may be inadequate initial treatment due to delayed diagnosis. Our case demonstrates the importance of early recognition and initiation of immunosuppressive therapy, potentially leading to dramatic clinical improvement, as seen in this patient.

Original languageEnglish (US)
Pages (from-to)162-166
Number of pages5
JournalThe Neurohospitalist
Issue number1
StatePublished - Jan 2022
Externally publishedYes


  • intracerebral hemorrhage
  • intracranial hemorrhage
  • intraparenchymal hemorrhage
  • neurosarcoidosis
  • sarcoidosis
  • seizure

ASJC Scopus subject areas

  • Clinical Neurology


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