Differentiating neurosarcoidosis from multiple sclerosis using combined analysis of basic CSF parameters and MRZ reaction

Vlad, Benjamin; Neidhart, Stephan; Hilty, Marc; Ziegler, Mario; Jelčić, Ilijas

doi:10.3389/fneur.2023.1135392

Cited by 4 publications

(3 citation statements)

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“…MRI aids in narrowing the differential diagnosis and can be used to demonstrate therapeutic response to immunosuppressive medication [ 31 ]. However, our study confirms previous work, that single parameters as imaging characteristics are not helpful to reliably distinguish neurosarcoidosis from MS [ 26 ].…”

Section: Discussionsupporting

confidence: 91%

“…As neurosarcoidosis is a serious and often devastating disease that requires therapeutic interventions that differ significantly from those for multiple sclerosis patients, it is of great importance to reliably distinguish between these two diseases and to diagnose the respective disease early and correctly [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

“…Indices (AIs) and appears to be highly specific for MS [ 32 ]. Combined evaluation of basic CSF parameters and MRZ reaction is powerful in differentiating neurosarcoidosis from MS, with moderate to severe pleocytosis and QAlb elevation and absence of intrathecal IgG synthesis as useful rule-in parameters and positive MRZ reaction as a rule-out parameter for neurosarcoidosis [ 26 ]. However, it would be favorable in the future to develop a reliable combination of cerebrospinal fluid (CSF) parameters, specific radiological and suggestive clinical features that would obviate the need for an invasive biopsy [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

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Cerebral lesions sites in neurosarcoidosis: a lesion mapping study

et al. 2023

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Background and purpose Sarcoidosis is a granulomatous disease of unknown etiology affecting the central nervous system in up to 15% of the patients. Diagnosis of neurosarcoidosis is very challenging due to the heterogeneity of its clinical manifestation. This study intended to evaluate the distribution of cerebral lesion sites and the potential presence of specific lesion clusters in neurosarcoidosis patients using voxel-based lesion symptom mapping (VLSM). Methods Patients with neurosarcoidosis were retrospectively identified and included between 2011 and 2022. Cerebral lesion sites were correlated voxel-wise with presence and absence of neurosarcoidosis using non-parametric permutation test. Multiple sclerosis patients served as controls for the VLSM-analysis. Results Thirty-four patients (mean age 52 ± 15 years) of whom 13 were diagnosed with possible, 19 with probable and 2 with confirmed neurosarcoidosis were identified. Lesion overlap of neurosarcoidosis patients demonstrated a distribution of white matter lesions in all brain areas, with a periventricular predilection similar to multiple sclerosis. In contrast to multiple sclerosis controls, no propensity for lesions in proximity of the corpus callosum was observed. Neurosarcoidosis lesions appeared smaller and lesion volume was lower in the neurosarcoidosis cohort. The VLSM analysis showed minor associations between neurosarcoidosis and damaged voxels in the bilateral frontobasal cortex. Conclusions The VLSM analysis yielded significant associations in the bilateral frontal cortex, suggesting that leptomeningeal inflammatory disease with following cortical involvement is a quite specific feature in neurosarcoidosis. Lesion load was lower in neurosarcoidosis than in multiple sclerosis. However, no specific pattern of subcortical white matter lesions in neurosarcoidosis was revealed.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%