[Psycho-neurological symptoms and raised angiotensin-converting enzyme in cerebrospinal fluid in a patient with sarcoidosis beginning in the central nervous system].

A 30-year-old man with sarcoidosis was reported. The initial presentation of sarcoidosis was psychiatric symptoms which included abnormal behavior, hallucination and delirious state. After complete remission of these symptoms, eight months later, organic psychosis reappeared with corectopia, bilateral sensory deafness and staggering gait of bilateral vestibular origin. On admission there was no hilar lymphnode enlargement in chest roentgenogram nor raised angiotensin-converting enzyme (ACE) in serum and it was difficult to make diagnosis. Fourteen months after the onset of psychotic symptoms, bilateral facial palsy appeared and they led us to correct diagnosis of sarcoidosis by reinvestigation of the lesions of the chest. It seemed that corectopia indicated lesion of midbrain tegmentum and deafness and staggering gait indicated bilateral VIIIth nerve dysfunction. ACE and IgG-synthesis rate in the cerebrospinal fluid was raised against normal values of ACE and IgG in the serum. These findings seemed to contribute to the early diagnosis of sarcoidosis which had a selective activity in the central nervous system.