Pattern and concentration of IgG in cerebrospinal fluid in neurosarcoidosis

Scott, Thomas F.; Seay, Alan R.; Goust, Jean‐Michel

doi:10.1212/wnl.39.12.1637

Cited by 25 publications

(12 citation statements)

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“…In two large studies of neurosarcoidosis, increased protein, increased lymphocytes, or both were reported in 73% and 81% of patients [16,17]. Although an increased IgG index can be seen, the presence of oligoclonal bands is rare [9,75,76], with rare cases reported in patients who have neurosarcoidosis [77]. Where appropriate, cultures and special stains should be performed to exclude other granulomatous and infectious diseases, particularly tuberculosis and Cryptococcus.…”

Section: Cerebrospinal Fluid Analysismentioning

confidence: 99%

Neurosarcoidosis

Lower

Weiss

2008

Clinics in Chest Medicine

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Although neurosarcoidosis seems to occur in only 5% to 10% of patients who have sarcoidosis, it may lead to significant complications. The diagnosis of neurosarcoidosis usually relies on indirect information from imaging and spinal fluid examination. Although MR imaging remains the most sensitive technique for detecting neurologic disease, other tests, including positron emission tomography scanning and cerebral spinal fluid examination, can provide important information. The role of immunosuppressive agents such as methotrexate, cyclophosphamide, and azathioprine has been expanded, and these agents should be considered for the treatment of some manifestations of neurosarcoidosis. Reports of the antitumor necrosis factor agent infliximab suggest that this drug can be helpful for patients who have neurosarcoidosis.

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Section: Cerebrospinal Fluid Analysismentioning

confidence: 99%

Neurosarcoidosis

Lower

Weiss

2008

Clinics in Chest Medicine

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“…Furthermore, increases in the concentration of ACE (ref. 26,27,[33][34][35][36][37] ), IgG-index [38][39][40] , oligoclonal bands 38,39,41 , CD4/CD8 lymphocyte ratios 42 , lysosymes and beta 2-microglobulin concentrations 43 in CSF have been reported. Most studies report evidence of intrathecal synthesis of immunoglobulins with oligoclonal bands in about 30-40% of patients with NS (ref.…”

mentioning

confidence: 99%

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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“…1; CSF sIL-2R was not detectable with oligoclonal IgM and IgG bands in CSF persisting after steroid treatment and clinical remission [7]. Also, in a recent study of 7 cases, oligoclonal bands in CSF were detected in 2 patients with normal IgG indices [20], however, the authors failed to state whether bands were also positive in the parallel serum samples, which would indicate an unselective B-cell activation. CSF L Z M has been proposed as a helpful marker for detecting CNS involvement in systemic sarcoidosis.…”

Section: Discussionmentioning

confidence: 86%

Neurosarcoidosis without systemic sarcoidosis

Sommer

Weller

Petersen

et al. 1991

Eur Arch Psychiatry Clin Nuerosci

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Neurosarcoidosis is a well-recognised complication of systemic sarcoidosis but diagnosis may be difficult if there is no clear evidence of an extracerebral manifestation of the disease. We present the case of a 42-year-old woman with clinical features characteristic of cerebral sarcoidosis including tetraparesis, diabetes insipidus, diencephalic hyperphagia, personality changes, and memory loss. Diagnosis was supported by cerebrospinal fluid (CSF) findings and magnetic resonance imaging (MRI): CSF showed mild lymphocytic pleocytosis, intrathecal production of IgG without oligoclonal bands, and a raised level of lysozyme. MRI revealed multiple contrast-enhanced granulomas at the base of the brain with partial involvement of diencephalic and mesencephalic structures and parts of the spinal cord. There was no evidence of systemic manifestation of sarcoidosis. Administration of corticosteroids led to improvement of the symptoms.

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Pattern and concentration of IgG in cerebrospinal fluid in neurosarcoidosis

Cited by 25 publications

References 0 publications

Neurosarcoidosis

Neurosarcoidosis

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

Neurosarcoidosis without systemic sarcoidosis

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