Biopsy-proven isolated sarcoid meningitis

Mayer, Stephan A.; Yim, Gregory K.; Onesti, Stephen T.; Lynch, Timothy; Faust, Phyllis L.; Marder, Karen

doi:10.3171/jns.1993.78.6.0994

Cited by 42 publications

(27 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Due to the wide spectrum of neuroradiological findings [5,11,21,28,30,31,32,35,40,48,56] and non-specific clinical signs and symptoms intracranial sarcoid granulomatosis can be mistaken for primary brain tumours, such as glioma [11,48,49], meningioma [5,17,26,30,31,32,33,42,44,47,50], and intrasellar masses [15,53] as well as infectious disorders of the central nervous system (CNS) [37,48,50].…”

mentioning

confidence: 99%

See 1 more Smart Citation

Neurosarcoidosis: a review of its intracranial manifestation

Nowak

Widenka

2001

Journal of Neurology

279

183

View full text Add to dashboard Cite

Sarcoidosis is a multisystem disease of unknown cause and with a worldwide distribution. Involvement of the central nervous system occurs in a relatively small number of patients with sarcoidosis. Isolated neurosarcoidosis without signs of systemic disease is a rarity. Because of its non-specific clinical presentation and neuroradiological imaging characteristics, intracranial neurosarcoidosis remains a very difficult diagnosis, particularly in the absence of systemic signs of the disease. Intracranial neurosarcoidosis has a predilection for the basal leptomeninges commonly affecting the cranial nerves, but any part of the brain may be involved, resulting in a wide spectrum of clinical syndromes. Cranial nerve involvement is the most common single symptom. Intracranial sarcoid manifests as nodular or diffuse leptomeningeal thickening and extraor intra-axial parenchymatous lesions. Intracranial sarcoid may mimic various forms of meningitis, including carcinomatous and intracranial mass lesions such as meningioma, lymphoma and glioma, based on neuroradiological imaging. Magnetic resonance imaging is a very sensitive diagnostic tool for detecting intracranial abnormalities due to neurosarcoidosis. Lumbar puncture is useful in ruling out other neurological disorders, in particular infectious, but cerebrospinal fluid findings are not specific. Angiotensin-converting enzyme in serum and cerebrospinal fluid may be increased, decreased or normal. Therapy consists of immunosuppressive agents and should be initiated with corticosteroids. Other immunosuppressive drugs should be added in severe cases or after frequent recurrences. We review here all aspects of intracranial neurosarcoidosis from the clinical point of view, with special emphasis on presentation, diagnostic procedures, differential diagnostic considerations and treatment.

show abstract

mentioning

confidence: 99%

“…s Key words Central nervous system · Intracranial neurosarcoidosis · Solitary neurosarcoidosis · Review 37,44,47,50,59]. Systemic signs of sarcoidosis include bilateral hilar lymph adenopathy, diffuse pulmonary infiltration, skin, liver and eye lesions [13].…”

mentioning

confidence: 99%

Neurosarcoidosis: a review of its intracranial manifestation

Nowak

Widenka

2001

Journal of Neurology

279

183

View full text Add to dashboard Cite

show abstract

“…20 ). Sometimes mental status changes and polyradiculopathy could be present 21,22 . Our first patient suffered from poliradiculopathy and there were positive meningeal signs.…”

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

View full text Add to dashboard Cite

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.

show abstract

“…Am häu-figsten werden neuropsychologische und psychiatrische Auffälligkeiten beobachtet. In bis zu 90% treten Beschwerden wie Gedächtnisstörungen und kognitive Einbußen sowie Depressionen und Psychosen auf [1,18,22] [12,15,19,28,34,65]. Die Beschwerden der Erkrankten treten in der Regel akut oder subakut auf und kön-nen im Verlauf remittieren.…”

Section: Neuropsychiatrischer Lupus Erythematodes (Nl)unclassified

“…Zu einer Neurosarkoidose kommt es bei etwa 5-10% der Patienten, wobei histopathologische Studien in bis zu 60% einen Befall des zentralen Nervensystems nachweisen konnten [14,34,43,56]. Demnach wird die tatsächliche Häufigkeit der Neurosarkoidose aufgrund blander Verläufe und diagnostischer Schwierigkeiten erheblich in unseren Augen unterschätzt.…”

Section: Neurosarkoidose (Ns)unclassified

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

Reske

2004

Nervenarzt

View full text Add to dashboard Cite

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.

show abstract

Biopsy-proven isolated sarcoid meningitis

Cited by 42 publications

References 11 publications

Neurosarcoidosis: a review of its intracranial manifestation

Neurosarcoidosis: a review of its intracranial manifestation

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

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

Contact Info

Product

Resources

About