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Neurosarcoidosis – Heerfordt Syndrome — SCE Neurology MCQ

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HardCNS InfectionsNeurosarcoidosis – Heerfordt SyndromeSCE Neurology

A 60-year-old woman with known sarcoidosis presents with progressive bilateral facial weakness, parotid gland enlargement, and anterior uveitis. MRI brain shows enhancement of the meninges at the skull base and enhancement of both facial nerves. CSF shows lymphocytic pleocytosis, elevated protein, and reduced glucose. What is the most likely diagnosis?

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Correct answer: C — Neurosarcoidosis with Heerfordt syndrome

Heerfordt syndrome (uveoparotid fever) is a specific manifestation of neurosarcoidosis characterised by bilateral facial nerve palsy, parotid gland enlargement, uveitis, and low-grade fever. Meningeal enhancement and cranial neuropathy on MRI with lymphocytic CSF pleocytosis and low glucose support neurosarcoidosis. A: Bell palsy is unilateral and idiopathic. C: GBS would have albuminocytological dissociation. D: Lyme could cause bilateral facial palsy but not parotid enlargement and uveitis together. E: Sjögren syndrome causes parotid enlargement but not typically this triad.

Reference: ABN Neurosarcoidosis Guidelines; EAN/EFNS Neurosarcoidosis Consensus (2014)