Facial numbness: a manifestation of sarcoidosis.

Facial numbness can pose a diagnostic dilemma for physicians. The trigeminal nerve can be affected by neoplasms in the nasopharynx, multiple sclerosis, dental and facial trauma, vertebrobasilar disease, carotid aneurysm, collagen vascular disease, infections including sinusitis and syphilis, and sarcoidosis. A careful history, physical examination, and prudent diagnostic studies are necessary to assess a patient with facial numbness. Sarcoidosis, an idiopathic disorder characterized by noncaseating granulomas, has an incidence of 11 cases per 100,000 population in the United States. l Sarcoidosis can affect one or many organs, including the lungs, lymph nodes, eyes, skin, heart, liver, and nervous system. According to most reports, the nervous system is affected in about 5 percent of patients with sarcoidosis.l-4 Sharma and Sharma,S however, report that 10 percent of patients with sarcoidosis have nervous system involvement, and the finding of subclinical neurosarcoidosis is even greater. The case described below illustrates the importance of recognizing that facial numbness might be a manifestation of sarcoidosis.