Abstract Details

Title Stroke in Patients with Sarcoidosis: A Comprehensive Review of 42 Reported Cases

Topic Autoimmune Neurology

Presentation(s) P6 - Poster Session 6 (5:30 PM-6:30 PM)

Poster/Presentation
Number 9-003

Background Stroke is rarely a presenting manifestation of neurosarcoidosis. Although granulomatous vasculitis has been proposed as a mechanism, the causes of stroke in sarcoidosis remain unclear, and the literature on this rare presentation is limited.

Objective To review the clinical presentation, diagnostic features, and outcomes of stroke in patients with sarcoidosis.

Design/Methods PubMed and Embase were searched for terms of "sarcoidosis / neurosarcoidosis" and encompassing terms for stroke. Cases were independently reviewed by two authors, with the following inclusion criteria: biopsy confirmed sarcoidosis in any body region, and stroke confirmed by imaging.

Results

Out of 1208 articles screened, 40 articles were included. 42 cases were abstracted, with 7 cases of recurrent strokes. Of the cases, 67% were male, mean age 40 (SD 14.5), and 60% had no other comorbidities at the time of stroke. Strokes were the first symptom of sarcoidosis in 45%. Pathologic confirmation of sarcoidosis was from an extracranial lymph node in 52%.

There were 72% ischemic and 28% hemorrhagic strokes. Stroke was supratentorial in 65%, infratentorial in 24%, and both in 9%. 43% had multifocal strokes on evaluation. The most common presentation was weakness (50%) followed by cranial nerve dysfunction (36%). 14 cases had brain biopsies, of which there were 2 reported pathological cases of vessel wall granuloma.

On brain imaging, 41% had findings suggestive of neurosarcoidosis and 28% had evidence of meningeal enhancement. 43% were treated with corticosteroids, with varying clinical improvement.

Conclusions Stroke associated with neurosarcoidosis generally follows trends in stroke incidence, with infarction being more common and male sex carrying a higher risk. Interestingly, many reported cases were diagnosed with sarcoidosis during their stroke episode. There were few clear reports of pathologically proven granulomatous vasculitis in sarcoidosis causing ischemic strokes.

Authors/Disclosures
Danielle Kei Pua, MD (Brigham and Women's Hospital) PRESENTER	Ms. Pua has nothing to disclose.
Pria Anand, MD (Boston University School of Medicine)	Dr. Anand has nothing to disclose.
Shamik Bhattacharyya, MD, FAAN (Brigham and Women's Hospital)	Dr. Bhattacharyya has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion Pharmaceuticals. Dr. Bhattacharyya has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Continuum. Dr. Bhattacharyya has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Merck. The institution of Dr. Bhattacharyya has received research support from Alexion Pharmaceuticals. The institution of Dr. Bhattacharyya has received research support from National Institute of Health. The institution of Dr. Bhattacharyya has received research support from UCB. The institution of Dr. Bhattacharyya has received research support from Genentech. Dr. Bhattacharyya has received publishing royalties from a publication relating to health care. Dr. Bhattacharyya has received publishing royalties from a publication relating to health care. Dr. Bhattacharyya has received publishing royalties from a publication relating to health care.