Objective: We here describe a patient with neurosarcoidosis presenting with progressive gait disturbance that mimics Parkinsonian syndrome.

Background: Neurosarcoidosis can show various neurological complications; however, bilateral vestibulopathy due to neurosarcoidosis is rare.

Method: Case report.

Results: A 68-year-old woman presented with an 18-month history of gait disturbances and weight loss. Neurological examination showed reduced facial expression, dysphagia, and slowness of movements. Eye movement was intact. The patient showed marked postural instability and was unable to stand without assistance. Superficial and deep sensations were normal. Given these neurological findings, Parkinsonian syndrome was initially suspected. However, dopamine transporter scan showed no presynaptic dopaminergic dysfunction. Bilateral vestibulopathy was considered based on the caloric irrigation showing a peak slow phase velocity of horizontal nystagmus and abnormal head tilt testing. Although she did not complain of difficulty hearing, sensorineural hearing loss was detected by audiogram. Repeated cerebrospinal fluid examinations showed mononuclear pleocytosis. Brain MRI showed diffuse cortical atrophy and enlarged third and lateral ventricles. FDG-PET scan showed abnormal uptake in the mediastinal lymph nodes. Histopathology of the lymph node showed non-caseous granuloma leading to a diagnosis of sarcoidosis. Steroid therapy resulted in improvement in her muscle weakness.

Conclusion: Neurosarcoidosis should be included in the differential diagnosis of patients with progressive gait and balance impairment.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/bilateral-vestibulopathy-due-to-neurosarcoidosis-mimicking-parkinsonian-syndrome/