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Approximately 5% to 15% of patients with systemic sarcoidosis develop neurological complications. However, the actual prevalence of subclinical disease may be higher. Symptoms are not specific, and may resemble those of other neurological diseases. Hydrocephalus occurs in 6% of patients with neurosarcoidosis. Acute hydrocephalus is extremely rare and when it occurs, it is usually difficult to diagnose, thus leading to possible complications. We present a patient who developed acute hydrocephalus due to neurosarcoidosis, for which he had to be operated on; soon after the operation, cranial infection developed that required definitive drainage system and ventriculoperitoneal shunt had to be implanted. In further complicated clinical course, after four years on corticosteroid therapy (corticosteroid dependent sarcoidosis), he had to be urgently operated on because of significant ventricular catheter adhesions, but several days after the operation he died in coma because of progressive brain edema not responding to treatment. As hydrocephalus due to neurosarcoidosis has high morbidity and mortality, early diagnosis and proper treatment are of utmost importance., Oko 5% do 15% bolesnika sa sistemskom sarkoidozom razviju neurološke komplikacije. Međutim, stvarna učestalost subkliničke bolesti može biti veća. Simptomi nisu specifični, a mogu sličiti onima drugih neuroloških bolesti. Hidrocefalus se pojavljuje u 6% bolesnika s neurosarkoidozom. Akutni hidrocefalus je iznimno rijedak, a kada se pojavi obično se teško dijagnosticira, što dovodi do mogućih komplikacija. Prikazujemo bolesnika u kojega se razvio akutni hidrocefalus zbog neurosarkoidoze, zato je morao biti operiran, no ubrzo nakon operacije kranijuma razvija se infekcija koja zahtijeva definitivnu kanalizaciju, ugradnju ventrikularnog šanta. U daljnjem kompliciranom kliničkom tijeku, nakon četiri godine kortikosteroidne terapije (o kortikosteroidima ovisna sarkoidoza), morao je biti hitno operiran zbog značajnih priraslica na ventrikularnom kateteru, ali je nekoliko dana nakon operacije umro u komi zbog progresivnog edema mozga koji nije reagirao na liječenje. Kako hidrocefalus kod neurosarkoidoze ima visok pobol i smrtnost, rano otkrivanje i odgovarajuće liječenje osobito su važni.

Diagnosis of Wegener’s granulomatosis at the early stage is difficult because of the nonspecific symptoms which mimic other disorders. The aim of this paper is to describe clinical and radiological features of Wegener’s granulomatosis (WG) in a Serbian population at initial presentation. A retrospective review of 37 patient's case records was carried out. All those patients were diagnosed with WG and they attended the Institute for lung diseases in Belgrade over the period of 15 years. There were 20 males and 17 females, ranging in age from 18 to 73 years (mean age 46.2 years). The mean period from the onset of the first symptoms to diagnosis of WG was 4.59±6.15 months. The criteria of American College of Rheumatology were fulfilled in all patients. Twenty-five of 37 patients had systemic, generalized form of WG and while 12 of them had a limited involvement of upper and lower respiratory system. The frequency of different system involvement was: upper respiratory tract 64.8%, lower respiratory tract 100%, kidneys 67.5%, musculoskeletal system 40.5%, skin 27.2%, eyes 8.1%, and nervous system two patients. ANCA (antineutrophil cytoplasmic antibodies) test was positive in 32((86.5%) patients, and negative in 5(13.5%). All patients were ANA negative. Histological evidence of granulomatous vasculitis was obtained in 34(91.9%), whereas in three patients the diagnosis was based on clinical manifestations and positive c-ANCA test. There are minor variations in our data when compared with those reported in literature.