skip to main content

Neurosarcoidosis – Hypothalamic-Pituitary Involvement — SCE Neurology MCQ

Instant feedback + full explanation. One question, done properly.

HardCNS InfectionsNeurosarcoidosis – Hypothalamic-Pituitary InvolvementSCE Neurology

A 39-year-old has subacute visual loss from optic neuropathy, diabetes insipidus and hypothalamic-pituitary stalk enhancement. Chest CT shows bilateral hilar and mediastinal lymphadenopathy. Which next diagnostic step offers the best balance of diagnostic yield and neurological safety?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Arrange EBUS-guided biopsy of an accessible mediastinal lymph node

The combination suggests neurosarcoidosis, but high-risk neural tissue should not be the first biopsy target when accessible systemic disease is present. Sampling an appropriate hilar, mediastinal or other extracranial site can demonstrate non-caseating granulomas and help exclude infection, malignancy and other granulomatous disorders while protecting vision and neurological function. Serum ACE lacks sufficient accuracy to establish the diagnosis. Neural biopsy is reserved for circumstances in which safer tissue is unavailable and diagnostic uncertainty remains clinically important.

Reference: Neurosarcoidosis: a clinical approach to diagnosis and management: https://pmc.ncbi.nlm.nih.gov/articles/PMC5413520/