Neurologic Manifestations of Sarcoidosis

Gullapalli, Dakshinamurty; Phillips, Lawrence H.

doi:10.1016/s0733-8619(03)00054-9

Cited by 102 publications

(70 citation statements)

References 109 publications

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“…Involvement of the central nervous system occurs in only 5-15% of cases 3,4 . Isolated neurosarcoidosis is rare: Spencer et al 12 found 10-17% of patients had isolated CNS involvement, while others detected systemic sarcoidosis in more than 95% of cases of sarcoidosis initially presenting with neurological symptoms 10 .…”

Section: Discussionmentioning

confidence: 99%

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An Unusual Presentation of Neurosarcoidosis in an 11-Year-Old Boy

Scholten

Hove²,

MacDonald³

2009

Can. j. neurol. sci.

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Sarcoidosis is a chronic, multisystem, granulomatous disease which typically develops between the ages of 20 and 40 years 1 . Neurosarcoidosis occurs in only 5-15% of adults with sarcoidosis, and is seldom reported in children [2][3][4][5] . Of the cases described in the literature, children were found more likely to present with seizures, and less commonly space-occupying lesions 6 . The tumefactive brain lesions are difficult to distinguish from the tumefactive demyelinating lesions of multiple sclerosis, from brain neoplasms, acute disseminated encephalo-myelitis (ADEM), or from parasitic foci 7,8 . We report the clinical and radiographic features of an 11-year-old boy with biopsy-proven neurosarcoidosis in order to highlight key features that distinguish neurosarcoidosis from tumefactive demyelination. CASE REPORTA previously healthy 11-year-old male presented in status epilepticus. The seizure started with an altered level of awareness and focal twitching of the right side of his face. The ictus lasted 45 minutes and responded to intravenous administration of lorazepam and phenytoin.Investigations revealed a peripheral white blood cell count of 28.2 (4.5-13 X10 9 /L), and normal hemoglobin and platelets. Electrolytes, glucose, renal and liver function, and coagulation parameters were normal. A toxicology screen was negative. Bacterial, viral, and fungal cultures were negative in blood. Cerebrospinal fluid (CSF) analyses revealed 20 X 10 6 /L leucocytes (90% lymphocytes), normal glucose and protein, no malignant cells, and negative bacterial and viral cultures. Polymerase chain reactivity for Herpes viruses was negative. Oligoclonal banding was detected, but as serum electrophoresis was not performed, this finding could not be evaluated. Serum anti-nuclear factor was negative.Computerized tomography of the head showed a focal, nonenhancing mass of the left frontal lobe with no evidence of mass effect or hydrocephalus. As shown in Figure 1, magnetic resonance imaging (MRI) demonstrated a region of increased T2/FLAIR signal involving the white matter of the left frontal lobe with leptomeningeal enhancement after gadolinium contrast administration. Magnetic resonance spectroscopy (MRS) demonstrated a lactate peak with normal choline and Nacetylaspartate. A second MRI obtained one week later showed improvement, with normalization of mass spectroscopy.Following recovery from the post-ictal period, the child was noted to have a normal neurological and general physical examination, including normal cognition and no focal deficits. Given the normal examination, and repeat MRI showing improvement in the lesion appearance, brain biopsy was THE CANADIAN JOURNAL OF NEUROLOGICAL SCIENCES 783

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Section: Discussionmentioning

confidence: 99%

“…Neurosarcoidosis occurs in only 5-15% of adults with sarcoidosis, and is seldom reported in children [2][3][4][5] . Of the cases described in the literature, children were found more likely to present with seizures, and less commonly space-occupying lesions 6 .…”

mentioning

confidence: 99%

An Unusual Presentation of Neurosarcoidosis in an 11-Year-Old Boy

Scholten

Hove²,

MacDonald³

2009

Can. j. neurol. sci.

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“…Asl›nda nörosar-koidoz s›kl›¤› otopsi serilerinde üç kat daha fazlad›r. [11] Sarkoid granülomlar›n›n beyin taban›na yerleflme e¤ilimi vard›r. En s›k yedinci kafa çifti tutulur, bunu üçüncü ve seki-zinci kafa çifti tutuluflu takip eder.…”

Section: Temel Bilgiler Ve Genel Klinik öZelliklerunclassified

Romatolog gözüyle sarkoidoz

Tarhan¹

2013

RAED Derg

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“…Die Szintigraphie ist in der Lage, durch vermehrte Aufnahme von 67 Gallium Granulome nachzuweisen. Aufgrund fehlender standardisierter Antigene nimmt der Kveim-Test keinen Platz mehr in der Routinediagnostik ein [21].…”

Section: Neurosarkoidose (Ns)unclassified

“…Die lymphomonozytäre Pleozytose liegt in der Regel unter 50/µl, im Rahmen einer meningealen Beteiligung kann sie jedoch auch bis zu 200/ µl erreichen [21]. Die Subanalyse der Lymphozyten zeigt eine erhöhte CD4:CD8-Ratio [56,57].…”

Section: Neurosarkoidoseunclassified

Cerebrospinal fluid and immunological parameters for differentiation of chronic inflammatory central nervous system disease

Reske

2004

Nervenarzt

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A number of neurological syndromes may be evoked by involvement of the nervous system due to systemic diseases such as lupus erythematosus, sarcoidosis, Behcet's disease, and Sjogren's syndrome. Because of different treatment strategies, it is important to distinguish between these different diseases. Neither clinical signs nor additional analyses such as serological findings or cerebrospinal fluid analysis are able to differentiate between the diseases with certainty. Nevertheless, diagnosis may finally be made taking all findings together. Here we compare typical clinical and cerebrospinal fluid findings in neurosarcoidosis, neurolupus, neuro-Behcet, and nervous system involving Sjogren's syndrome, with special emphasis on those findings allowing differentiation of the respective diseases.

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Neurologic Manifestations of Sarcoidosis

Cited by 102 publications

References 109 publications

An Unusual Presentation of Neurosarcoidosis in an 11-Year-Old Boy

An Unusual Presentation of Neurosarcoidosis in an 11-Year-Old Boy

Romatolog gözüyle sarkoidoz

Cerebrospinal fluid and immunological parameters for differentiation of chronic inflammatory central nervous system disease

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