Review: Case Report of Sarcoidosis with Mania

The paper reviewed here is ‘A possible case of mixed mania due to neurosarcoidosis treated successfully with methylprednisolone and ziprasidone: another example of frontal-subcortical disinhibition?’ by Kent and colleagues. This is a very brief case report on an African-American lady in her late 30’s who presents with hypomania and a previous suspicion of pulmonary/cardiac sarcoidosis on the basis of biopsy. The authors note that this was not treated although I wasn’t sure of the reason for this. She had been presenting with intermittent facial nerve palsy also. These details were confirmed on physical examination during the admission described in the report. There was no evidence of delirium although she was expressing bizarre delusions in the context of a labile mood. A provisional diagnosis of mania with psychotic symptoms was made and she was treated with a combination of Ziprasidone and Prednisolone and her hypomanic state had improved within 2 days. They provide supporting scores on the Young Mania Rating Scales, both on admission and discharge. The lady wasn’t able to undergo an MRI scan as she had a pacemaker and there was no evidence of neurosarcoidosis from the investigations although this was the presumed diagnosis. The authors suggest that Haloperidol given initially on admission or the Ziprasidone may have been associated with the rapid improvement as they cite other literature suggesting that response of psychiatric symptoms to steroid monotherapy in sarcoidosis takes between 2 and 4 weeks. The authors also note that without the radiological exclusion of alternative diagnoses they were not strictly able to confirm the neurosarcoidosis (NS) diagnosis on the basis of Zajicek’s criteria. Another possibility was this was Bipolar disorder.

I did a quick search of medline using the keyword ‘neurosarcoidosis’ as of 31.5.10 returned 543 results. I have listed a few of the papers that looked interesting below.

  • Canadian case study of ongoing cognitive decline in association with NS.
  • Dutch study on presentation as manic psychosis – as in current case report. Free full text but article is in Dutch.


Spiegel D.R, Thomas C.S, Shah P and Kent K.D. A possible case of mixed mania due to neurosarcoidosis treated successfully with methylprednisolone and ziprasidone: another example of frontal-subcortical disinhibition? General Hospital Psychiatry. Vol 32. Issue 3. May-June 2010. pp342.

Call for Authors: If you are interested in writing an article or series of articles for this blog please write to the e-mail address below. Copyright can be retained. Index: An index of the site can be found here. The page contains links to all of the articles in the blog in chronological order. Twitter: You can follow ‘The Amazing World of Psychiatry’ Twitter by clicking on this link. Podcast: You can listen to this post on Odiogo by clicking on this link (there may be a small delay between publishing of the blog article and the availability of the podcast). It is available for a limited period. TAWOP Channel: You can follow the TAWOP Channel on YouTube by clicking on this link. Responses: If you have any comments, you can leave them below or alternatively e-mail Disclaimer: The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog.

One comment

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s