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Neurosarcoidosis – Cauda Equina Syndrome — SCE Neurology MCQ

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HardCNS InfectionsNeurosarcoidosis – Cauda Equina SyndromeSCE Neurology

A patient has subacute cauda equina enhancement and inflammatory CSF. EBUS-guided mediastinal-node biopsy shows non-caseating granulomas; microbiology and lymphoma assessment are negative, but neural tissue has not been sampled. Under contemporary neurosarcoidosis criteria, what level of diagnostic certainty is supported?

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Correct answer: A — Probable neurosarcoidosis with compatible neurology and biopsy-proven systemic disease

Definite neurosarcoidosis requires pathological confirmation from nervous-system tissue. A compatible neurological syndrome plus biopsy-proven systemic sarcoidosis, after reasonable exclusion of infection, malignancy and other granulomatous disease, supports probable neurosarcoidosis. The EBUS biopsy is valuable precisely because it provides lower-morbidity systemic tissue; it does not convert the case to definite disease. Without any pathological confirmation the corresponding category would generally remain possible.

Reference: Neurosarcoidosis: Pathophysiology, Diagnosis, and Treatment. https://pmc.ncbi.nlm.nih.gov/articles/PMC8495503/