Primary cerebral sarcoid granuloma: the importance of definitive diagnosis in the high-risk patient population

Sarcoidosis of the central nervous system has been variously reported in 5–15% of all sarcoid patients. However, presentation of sarcoidosis as an isolated ‘intracranial tumor’ is rare. A 35-year-old African–American woman presented with intractable headaches. Neuroimaging revealed a tumor that was suggestive of a glioma or meningioma or metastasis. The symptoms did not respond to steroids, and an open biopsy of the lesion revealed non-caseating granuloma. A thorough work-up for systemic sarcoidosis was negative. The patient remains symptom-free at a 2-year follow-up. Primary sarcoid granuloma of the brain is rare. Once systemic disease has been excluded, early tissue diagnosis is crucial. This is particularly relevant for patients in the high-risk population before considering empirical radiosurgery.