Magnetic resonance imaging and symptoms in patients with neurosarcoidosis and central diabetes insipidus

Introduction: In the clinical setting, the diagnosis of neurosarcoidosisin patients with central diabetes insipidus(CDI) is typically based both on symptoms (i.e. polydipsiaor polyuria) and brain magnetic resonance imaging (MRI) findings (e.g. pituitary abnormality). However, inconsistent changes in the patient’s symptoms and brain MRI findings may occur during the clinical course of the disease. This review was performed to summarise the relationship between symptoms and brain MRI findings in previously reported cases of neurosarcoidosiswith CDI. Material and methods: Case studies of patients diagnosed with neurosarcoidosiswith CDI were collected via a PubMed search of studies published through 30 June 2018. Results: Thirteen eligible studies were reviewed (20 patients; 12 men, 8 women; mean age 33 years). Polydipsiaor polyuriawas the first symptom in 13 patients. The mean duration from disease onset to diagnosis was 3.4 months. Brain MRIs showed abnormal findings in the hypothalamus and pituitary for 17 patients. Immunosuppressive drugswere used in 17 patients. For 14 patients, MRI findings improved, while symptoms did not. Conclusion: Patients with both neurosarcoidosisand CDI symptoms often do not improve, despite the fact that brain MRI findings often improve following treatment. More studies involving detailed pathological analyses and longer follow-up periods are necessary.