7.3.1 Headache attributed to neurosarcoidosis

Identification: Sex/Age: Female, 38 years History: Pulmonary sarcoidosis diagnosed 2 years ago (under treatment with prednisone 20 mg/day) Medication: Irregular corticosteroid therapy in the last 3 months History of Present Illness (HPI): Main symptom: Daily headache for 6 weeks Pain characteristics: Location: Bifrontal Character: Continuous pressure Intensity: 7/10 Aggravating factors: Cough and Valsalva maneuvers Associated symptoms: Progressive blurred vision Weakness in the right lower limb Intense fatigue Physical/Neurological Examination: General: Febrile (37.8°C), weight loss of 5 kg in the last month Neurological: Paresis grade 4/5 in the right lower limb Bilateral papilledema Cranial nerves: Left peripheral cranial nerve VII Complementary Exams: Brain MRI: Basilar meningitis with communicating hydrocephalus CSF: Lymphocytosis (50 cells/mm³) Elevated proteins (80 mg/dL) Low glucose (40 mg/dL) Chest CT Angiography: Bilateral hilar adenopathy Serum ACE: 85 U/L (normal value <40)