Sarcoidosis of the Central Nervous System*

Since Boeck (1), in 1899, first described the skin lesions of sarcoidosis and Schaumann (2), in 1914, the systemic form of the disease, sarcoidosis has aroused much interest among clinicians and pathologists alike. The etiology is still obscure. The theory that it is an atypical form of tuberculosis has many defenders, although it has never been proved bacteriologically. That it occurs in a benign form much more commonly than clinically suspected, is shown by the frequency with which it is found in lymph nodes removed because of carcinoma of the breast. Mter Winkler (3) had first described sarcoid lesions in the peripheral nerves, Heerfordt (4) reported cases of uveo-parotid fever with cranial nerve involvement. According to Levin (5), half of the patients with uveo-parotid fever suffer from cranial nerve palsies. Since then an increasing number of cases of sarcoidosis with neurological symptoms have been reported. Colover (6), in 1948, was able to collect 115 cases from the literature and added 3 of his own. Although the peripheral nerves are usually involved, resulting in peripheral neuritis or cranial nerve palsies, the brain and pituitary gland are not infrequently the seat of the disease. In a series of 22 fatal cases, Ricker and Clark (7) found 3 with involvement of the central nervous system. Because of the usually benign course of the disease, few cases are on record in which it was possible to examine histologically the lesions in the central nervous system. Among 20 cases of sarcoidosis, proved by autopsy in the Department of Pathology at the University of Toronto, 3 showed lesions in the central nervous system. These, with the addition of 2 others, from which the material was obtained at operation, are reported in this paper.