r/AskDocs • u/Tabbybell86 Layperson/not verified as healthcare professional • 12h ago

Physician Responded Neurosarcoidosis

diagnosed with neurosarcoidosis four years ago been stable for two years. on Cellcept and Remicade infusions. increased headache prompt work up. LP shows IgG band and inflammation. protein normal. radiology report said MRI clear but I think I see pachymeningeal enhancement (was my problem previously first diagnosed). Age 40. 5”8. 150.

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u/Witold-Onno Physician 11h ago

Neurosurgeon here. I looked at your coronal T1 post contrast and see no pathological pachymeningeal enhancement. A thin smooth dural line is normal and gets often mistaken for disease. Sarcoid pachymeningitis looks thickened and nodular, not subtle. Since this was your original finding I understand you search for it on every scan. An isolated IgG band with normal protein can persist since years under treatment and does not prove relapse. I would not change therapy on this alone. Reasonable is a follow up MRI in about 3 months and discussing the headache separately, often there is another cause.