Sarcoidosis of the Cerebellopontine Angle

Introduction: Sarcoidosis is a systemic chronic granulomatous disease, unknown etiology that affects the central nervous system in about 5% of the cases. The diagnosis requires the presence of clinical and radiographic manifestations; exclusion of other diseases with similar presentation and noncaseating granuloma on histopathology.

Case Presentation: A 69-year-old male patient, with a history of fall from a horse and since then started coughing episodes. Chest computed tomography (CT) was performed at that time showed lymph node enlargement. In 2010, he began presenting diplopia and cranial CT scan was performed, which identified a tumor in the brain, likely schwannoma. It created damage for 2 years with progressive growth and underwent surgery for resection and histopathology showed noncaseating granulomas. After surgery the patient evolved with total sensorineural hearing loss in his right ear and right hemifacial paresthesia.

Discussion: These lesions suggest vestibular nerve schwannoma that may present progressive deafness, vertigo, ataxia, and retroauricular pain. Neurosarcoidosis can affect the central nervous system or peripheral and affected patients may not have systemic features of the disease. Usually manifests with paralysis of cranial nerves and rarely imitates an intracranial tumor as in our case.

Final comments: Sarcoidosis of the cerebellopontine angle is a rare disease and should be a differential diagnosis in patients with clinical and radiological manifestations of sarcoidosis and the presence of brain injury suggestive of intraparenchymal schwannoma. Probably the patient had a diagnosis of sarcoidosis since the first chest CT with hilar adenopathy.

Keywords: Cerebellopontine angle, sarcoidosis, schwannomas.