Abstract Number ‐ 268: Sarcoid Induced Posterior Circulation Abnormality With Recurrent Ischemic Strokes

Abstract

Introduction The estimated incidence of Neurosarcoidosis is ∼5‐15%. Most of these cases involve anterior circulation. Here we are presenting a case of recurrent posterior circulation ischemic stroke in a patient with neurosarcoidosis. Methods A 41‐year‐old Male had biopsy proven sarcoidosis diagnosed in 2012 with pulmonary involvement. He was on chronic low dose Corticosteroid. In 2014, he presented with right pontine ischemic infarction causing left‐sided hemiplegia. He underwent extensive workup including conventional angiogram that showed irregular intracranial left vertebral artery with mild narrowing distal to posterior inferior cerebellar artery (PICA) and mild dilatation proximal to basilar artery (Image on the top). He was started on Aspirin 81 mg. In 2021, he had a right inferior cerebellar peduncle infarction with repeat angiogram showing abnormal dysplastic dilatation of the left vertebral artery at V4 segment and the top of basilar artery that has progressed since 2014 (image on the bottom). Workup showed that he was Aspirin non‐responder and has been switched to Clopidogrel. Results The most common presentation of neurosarcoidosis is cranial neuropathy, mostly facial nerve. Ischemic stroke is one of the uncommon presentation of neurosarcoidosis. The likely mechanism could begranulomatous invasion of the blood vessel wall with vasculitic disruption of the media and internal elastic lamina. Conclusions To our knowledge, this is a rare case of neurosarcoidosis progressively affecting posterior circulation causing recurrent stroke.