Disclosures: LaTanya Lofton, MD: No financial relationships or conflicts of interest

Objective: To describe a rare presentation of neurosarcoidosis

Design: Case presentationSetting : Acute inpatient rehabilitation unitParticipants : 39 year old male presented with acute onset of aphasia, double vision, involuntary movements, and subsequent tetraplegia.

Interventions: Initial magnetic resonance imaging showed restricted diffusion in the ventral aspect of the medulla and signal changes in the midline pons. Magnetic resonance imaging of the cervical, thoracic, and lumbar spine was negative for acute pathology. Extensive workup was initiated, and he was also found to have evidence of mediastinal lymphadenopathy on CT scan of the chest. Biopsy of the lymph nodes was consistent with noncaseating granuloma. Infectious workup was negative. CSF ACE level was within normal limits. Ultimately, a diagnosis of neurosaroidosis was made.

Main Outcome Measures: N/A

Results: This patient was initially treated with corticosteroids and cyclophosphamide. He developed hemorrhagic cystitis due to cyclophosphamide, and this was discontinued. He was then treated with infliximab infusion and ongoing corticosteroids while he was admitted to inpatient rehabilitation. He is now more than one year post diagnosis, and he is now taking methotrexate weekly and monthly rituximab infusion. His speech is fluent and nondysarthric. He denies any visual or respiratory problems. While he was initially noted to have minimal upper and lower extremity strength on initial presentation, he is noted to have improved strength in the arms and hands. Manual muscle testing examination shows 3/5 bilateral elbow flexion and wrist extension strength. He remains paralyzed in the bilateral lower extremities. His clinical course has been further complicated by neurogenic bladder and bowel. Follow up imaging of the brain and spine have been consistent with chronic changes in the pons and medulla and absence of abnormalities in the spine.Conclusions: Ischemic stroke is a rare presentation of neurosarcoidosis, and physiatrists should be aware of the management of stroke and other neurological conditions associated with neurosarcoidosis.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/neurosarcoidosis-presenting-as-acute-pontine-and-medullary-infarction/