Neurosarcoidosis: a clinical approach to diagnosis and management

Ibitoye, Richard; Wilkins, Alastair; Scolding, Neil

doi:10.1007/s00415-016-8336-4

Cited by 87 publications

(104 citation statements)

References 40 publications

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“…CSF analysis may demonstrate a lymphocytic pleocytosis, elevated protein, low glucose, elevated immunoglobulin G index, and CSF-unique oligoclonal bands in NS; however, the sensitivity and specificity of these assays are low. 5,8, 64,65 Recently, the values of CD4/CD8 ratio and interleukin-6 (IL-6) in CSF were studied in 47 NS patients. A CD4/CD8 ratio >5 was highly suggestive for active NS.…”

Section: Diagnostic Approach Neurosarcoidosis Manifestationsmentioning

confidence: 99%

The Burden of Neurosarcoidosis: Essential Approaches to Early Diagnosis and Treatment

Voortman

Stern

Saketkoo

et al. 2020

Semin Respir Crit Care Med

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Neurosarcoidosis (NS) is an often severe, destructive manifestation with a likely under-reported prevalence of 5 to 15% of sarcoidosis cases, and in its active phase demands timely treatment intervention. Clinical signs and symptoms of NS are variable and wide-ranging, depending on anatomical involvement. Cranial nerve dysfunction, cerebrospinal parenchymal disease, aseptic meningitis, and leptomeningeal disease are the most commonly recognized manifestations. However, non-organ-specific potentially neurologically driven symptoms, such as fatigue, cognitive dysfunction, and small fiber neuropathy, appear frequently.Heterogeneous clinical presentations and absence of any single conclusive test or biomarker render NS, and sarcoidosis itself, a challenging definitive diagnosis. Clinical suspicion of NS warrants a thorough systemic and neurologic evaluation hopefully resulting in supportive extraneural physical exam and/or tissue findings. Treatment targets the severity of the manifestation, with careful discernment of whether NS reflects active potentially reversible inflammatory granulomatous disease versus inactive postinflammatory damage whereby functional impairment is unlikely to be pharmacologically responsive. Non-organ-specific symptoms are poorly understood, challenging in deciphering reversibility and often identified too late to respond to conventional immunosuppressive/pharmacological treatment. Physical therapy, coping strategies, and stress reduction may benefit patients with all disease activity levels of NS.This publication provides an approach to screening, diagnosis, disease activity discernment, and pharmacological as well as nonpharmacological treatment interventions to reduce disability and protect health-related quality of life in NS.

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Section: Diagnostic Approach Neurosarcoidosis Manifestationsmentioning

confidence: 99%

The Burden of Neurosarcoidosis: Essential Approaches to Early Diagnosis and Treatment

Voortman

Stern

Saketkoo

et al. 2020

Semin Respir Crit Care Med

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“…[2] In order to capture new developments in understanding sarcoidosis as it relates to eye disease, we searched the National Library of Medicine database using the key word, “ocular sarcoidosis”. We selected papers published since 2015 and ignored papers written in languages other than English or reports in the form of reviews.…”

Section: Introductionmentioning

confidence: 99%

“…Neurological involvement is observed in 5–26% of sarcoidosis cases[2]. Cranial neuropathy is the most frequent neurological manifestation; facial nerve and optic nerve are the most commonly affected.…”

Section: Introductionmentioning

confidence: 99%

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Ocular sarcoidosis

Yang

Salek²,

Rosenbaum

2017

Current Opinion in Pulmonary Medicine

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Purpose of review Ocular involvement in sarcoidosis is present in up to 80 percent of patients and is frequently manifested before diagnosis of the underlying systemic disease. Considering the therapeutic consequences, early diagnosis of the underlying disease is advantageous in patients presenting with ocular inflammation. There are several ocular findings suggestive of underlying sarcoidosis, such as granulomatous keratic precipitates, iris nodules, cells in the vitreous humor known as snowballs and snowbanks, and retinal periphlebitis. High suspicion is crucial for the diagnosis of sarcoidosis. This review on ocular sarcoidosis will mainly focus on new diagnostic and treatment modalities. Recent findings Recent studies found possible new diagnostic indicators for the diagnosis of ocular sarcoidosis which include not only serum profiles but also vitreous sample analysis. Ophthalmologic imaging techniques have improved to investigate the ocular structure in detail. Results from recent uveitis clinical trials have included sarcoidosis as an underlying cause and have reported positive results. Summary The diagnosis of ocular sarcoidosis can be challenging in some cases. High suspicion is important to diagnose ocular sarcoidosis with various laboratory and ophthalmic tools. There are many possible options for the treatment of ocular sarcoidosis including various biologic agents.

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“…3 Neurosarcoidosis can manifest in different fashions and reaching a diagnosis may be complicated especially if it presents with rare clinical symptoms. 2,5 Here, we present a case of neurosarcoidosis that presented with isolated oculomotor nerve palsy.…”

mentioning

confidence: 99%