Magnetic resonance imaging in central nervous system sarcoidosis

Miller, David H.; Kendall, B. E.; Barter, Susan; Johnson, Glenn D.; MacManus, David; Logsdail, Stephen; Ormerod, I. E. C.; McDonald, W. I.

doi:10.1212/wnl.38.3.378

Cited by 118 publications

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“…In the only other larger study performed in a neurological department, 90% of the patients with definite or probable neurosarcoidosis had pathological findings in cranial MRI [12]. Similar results were found in large series of patients with predominantly systemic disease [23, 24]. In our series, the prevalence of lesions in cranial MRI was somewhat smaller (64%).…”

Section: Discussionsupporting

confidence: 89%

Neurosarcoidosis: Clinical Experience and Diagnostic Pitfalls

Kellinghaus

Schilling

Lüdemann³

2004

Eur Neurol

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Objective: To describe a group of patients with neurosarcoidosis and to highlight diagnostic difficulties based on current diagnostic criteria. Methods: The patient database of a general neurological department was searched for patients with established or suspected diagnosis of neurosarcoidosis. Twenty-four patients were identified with definite (n = 3), probable (n = 10) and possible neurosarcoidosis (n = 10). History and clinical, laboratory and imaging data of patients with definite and probable neurosarcoidosis were analyzed. Results: Cranial nerve symptoms were a dominant clinical feature, with the optic nerve being affected most frequently. Cerebrospinal fluid pleocytosis was found in more than half of the patients. Intrathecal IgG synthesis and oligoclonal bands were less frequent. There was a wide array of MRI lesions in both groups. Chest X-ray was false negative in 2 of 5 patients who also underwent a thoracic CT. Therapy with prednisolone was initiated in all patients. After a median of 36 months, 6 of 8 patients with follow-up data of >24 months were still in remission. Aggravation of symptoms required therapy escalation in 2 patients. Conclusion: There is a wide range of clinical symptoms and test results in patients with ‘definite’ or ‘probable’ neurosarcoidosis. Because systemic involvement is a crucial diagnostic criterion, extensive medical work-up may be necessary. Prognosis under corticosteroid treatment may be better than previously thought.

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Section: Discussionsupporting

confidence: 89%

Neurosarcoidosis: Clinical Experience and Diagnostic Pitfalls

Kellinghaus

Schilling

Lüdemann³

2004

Eur Neurol

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“…About 40% of patients with NS have either leptomeningeal enhancement with gadolinium (present in the first patient), or multiple white matter lesions in the periventricular areas (present in our second patient) that may be difficult to distinguish from those seen in multiple sclerosis 49 . The unenhanced MRI is unsatisfactory because of the artifacts near bone, CSF and meninges on both T1 and T2-weighted images.…”

mentioning

confidence: 79%

Neurosarcoidosis: Two case reports with multiple cranial nerve involvement and review of the literature

Mijajlović¹,

Mirkovic²,

Mihailović-Vučinić³

et al. 2014

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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aBackground. Involvement of the central nervous system is registered in a relatively small number of patients with sarcoidosis. In this article we present two cases with various neurological symptoms that fulfill criteria for neurosarcoidosis (NS). In addition, we review the literature on NS with special attention to isolated cranial nerve involvement. Methods and Results. First patient: Neurological examination identified multiple cranial neuropathy, moderate rightsided hemiparesis, polyradiculoneuritis of the lower limbs and positive meningeal signs. Laboratory tests showed serum and cerebrospinal fluid (CSF) inflammatory abnormalities, with increased values of the angiotensin-converting enzyme (ACE). CSF analysis also showed presence of 9 oligoclonal IgG bands. Brain and spine magnetic resonance imaging (MRI) revealed diffuse meningopathy, and focal granulomatous lesion in the body of the L5 vertebra. Lung sarcoidosis was confirmed by additional diagnostic procedures. The patient was treated with Methylprednisolone and a tapering course of oral Prednisone, which reduced the pain in the back and legs and improved the strength of the right leg. However, the other neurological deficiencies remained. After confirming lung sarcoidosis, the patient received Methotrexate in addition to Prednisone but during the following 2 years the patient's condition progressively worsened and ended in death. Second patient: Neurological findings showed weakness of the right n. oculomotorius and the right n. trochlearis, as well as the right-side face weakness. We found raised level of the ACE in serum and CSF. Thorax high-definition computed tomography (HDCTT) showed ribbon-like domains of discrete changes in the pulmonary parenchyma. MRI of the brain showed multiple white matter lesions. This patient also received Methylprednisolone followed by Prednisone, and after two months, ocular motility normalized. Conclusion. The diagnosis of NS is always a challenge. For this rerason definitive diagnosis requires the exclusion of other causes of neuropathy. Multiple cranial neuropathies should always arouse suspicion of NS.

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“…O envolvimento das meninges é particularmente importante nas regiões basais provocando envolvimento dos pares cranianos e hidrocefalia. Miller e col. 32 chamam a atenção para a similaridade entre a neurosarcoidose e a EM em alguns casos nos quais ocorrem alterações difusas e simé-tricas da substância branca peri-ventricular com discretas lesões focais regionais. A causa de tais alterações de sinais periventriculares seria a presença do tecido de granulação da sarcoidose na região subependimária, o que já foi provado histo-patologicamente, e pequenas áreas de infarto secundários a microangiopatia difusa causada pela doença.…”

Section: Discussionunclassified

Ressonância magnética na esclerose múltipla: análise de 270 casos

Minguetti

2001

Arq. Neuro-Psiquiatr.

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RESUMO -O autor apresenta 270 casos de pacientes com história clínica e imagens de ressonância magnética compatíveis com esclerose múltipla. São feitas considerações sobre a incidência quanto ao sexo, grupos etários e localização das lesões. Por se tratar de doença considerada rara nos países tropicais, o autor tece considerações didáticas sobre os critérios clínicos e de imagem úteis na prática radiológica e alerta os neurologistas para o significado desta doença na capital (Curitiba) de um estado brasileiro (Paraná) situado entre os paralelos 22º e 30º Sul. PALAVRAS-CHAVE: esclerose múltipla, esclerose múltipla no Brasil, ressonância magnética na esclerose múltipla. Esclerose múltipla (EM) é a mais comum das doenças desmielinizantes 1,2 , sendo caracterizada pela localização de múltiplas placas de desmielinização na substância branca encefálica e medular. Estas lesões causam sinais e sintomas neurológicos intermitentes que, com a evolução da doença, podem agravar-se progressivamente. .oi Robert Carswell, professor de anatomia patológica de Londres quem primeiro publicou, em 1837, um caso de anomalias cerebrais coincidentes com quadro clínico de esclerose múltipla. Em 1838, Jean Cruveilhier, professor de anatomia patológica em Paris, publicou quatro casos associando os achados histopatológicos aos achados clínicos dos pacientes e já chamando a atenção para a característica intermitente da doença, com crises de exacerbação e remissão que ela produzia. .oi, porém, Jean-Martin Charcot quem, em 1870, através de uma série de casos, descreveu os critérios clínicos da EM e estabeleceu o caráter flutuante da sintomatologia desta doença. Ele também incluiu a neurite óptica, os envolvimentos bulbar e medular como parte do complexo da esclerose múltipla. Charcot também descreveu em detalhes os achados histológicos, dando ênfase à desmielinização das fibras nervosas encontradas nas placas, infiltrado perivascular de células plasmáticas, linfócitos e macró-fagos 3 . Em 1932 Pete e Chaltemberg deram um passo na elucidação da etiologia das placas de desmielinização. Através de um modelo animal, eles observaram que elas se associavam a um processo de natureza imunológica 3 . Em 1942, Cabot descreveu aumento de imunoglobulina (IgG) no líquor dos pacientes com esclerose múltipla. Era a primeira vez que a doença apresentava correlação com uma alteração laboratorial. O aumento da imunoglobulina liquórica permitiu aos pesquisadores reconhecer em 1960 que a esclerose múltipla se associava a uma gamopatia oligoclonal do líquor e que o aumento da IgG no líquor era devido a sua alta produção no sistema nervoso central 3 .Em 1970, a técnica do Potencial Evocado (visual, somatosensorial e do tronco cerebral) passou a ser utilizada, porém de forma limitada, pois a ausência ou lentidão das ondas de resposta indica uma lesão no complexo anatômico-fisiológico estudado, mas não que ela seja devida à esclerose múltipla. Estes testes só são úteis quando se buscam lesões subclínicas do sistema nervoso central nos casos sus-

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Magnetic resonance imaging in central nervous system sarcoidosis

Cited by 118 publications

References 0 publications

Neurosarcoidosis: Clinical Experience and Diagnostic Pitfalls

Neurosarcoidosis: Clinical Experience and Diagnostic Pitfalls

Neurosarcoidosis: Two case reports with multiple cranial nerve involvement and review of the literature

Ressonância magnética na esclerose múltipla: análise de 270 casos

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