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Images in Neurology
October 2008

Heart-Shaped Lesion Secondary to Neurosarcoidosis

Arch Neurol. 2008;65(10):1388-1389. doi:10.1001/archneur.65.10.1388

A 27-year-old man experienced a progressive, global, pressure headache followed by partial motor seizures. Initial neurologic evaluation results were normal. Brain magnetic resonance imaging revealed a heart-shaped enhancing lesion, which was located in the tentorium area and extended into the pineal region and superiorly along the posterior falx cerebri; it was initially interpreted as a meningioma (Figure). Because the lesion was not easily accessible and there was no mass effect on magnetic resonance imaging, we chose to treat the symptoms medically and to observe the clinical evolution before we suggested any kind of invasive diagnostic procedure or therapy. Symptoms subsided until a year later when the patient had new seizures. He underwent new brain magnetic resonance imaging, which did not show changes from the previous study. The lesion was biopsied and the pathology report confirmed the presence of a noncaseating granulomatous inflammation suggestive of sarcoidosis. The patient started treatment with prednisone (1 mg/kg/d), after which he did not report improvement, so oral methotrexate was added. His symptoms were improving at the last follow-up visit in our clinic several months ago.

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