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Nishida M, Namiki T, Sone Y, Hashimoto T, Tokoro S, Hanafusa T, Yokozeki H. Acquired anhidrosis associated with systemic sarcoidosis: quantification of nerve fibres around eccrine glands by confocal microscopy. Br J Dermatol 2017; 178:e59-e61. [PMID: 28796884 DOI: 10.1111/bjd.15880] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- M Nishida
- Department of Dermatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - T Namiki
- Department of Dermatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Y Sone
- Department of Dermatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - T Hashimoto
- Department of Dermatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - S Tokoro
- Department of Dermatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - T Hanafusa
- Department of Dermatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - H Yokozeki
- Department of Dermatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
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A Case of Atopic Myelitis with Cervical Cavernous Angioma. Case Rep Med 2017; 2017:9506275. [PMID: 28757876 PMCID: PMC5512020 DOI: 10.1155/2017/9506275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 06/01/2017] [Indexed: 11/17/2022] Open
Abstract
Atopic myelitis, a type of myelitis which appears in patients with elevated serum levels of immunoglobulin E (IgE), occurs more commonly in the cervical spinal cord, but this mechanism has not yet been elucidated. Herein, we experienced a case of atopic myelitis developed during the growth of cervical cavernous angioma caused by bleeding. A 37-year-old woman suffered from hand swelling caused by a house cat licking. At the same time when cavernous angioma had grown, she experienced a numbness in her four extremities, and multifocal peritumoral hyperintense spinal cord signals were seen. The diagnosis of atopic myelitis was made because we observed significantly elevated levels of specific IgE antibody to cat dander. Symptoms disappeared immediately after steroid pulse therapy. We subsequently resected a cavernous angioma, and eosinophil invasion was found inside it. This is the first case report of atopic myelitis which developed in association with spinal cord vascular lesions. A local blood-brain barrier breakdown due to hemorrhagic lesions of the spinal cord may have contributed to the onset of atopic myelitis.
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18 F-FDG-PET/CT guiding to diagnosis of neurosarcoidosis. Rev Esp Med Nucl Imagen Mol 2017; 36:269-270. [DOI: 10.1016/j.remn.2016.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Revised: 12/01/2016] [Accepted: 12/03/2016] [Indexed: 11/18/2022]
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Guglielmo P, Crivellaro C, Marzorati L, Patassini M, Morzenti S, Landoni C. 18 F-FDG-PET/CT guiding to diagnosis of neurosarcoidosis. Rev Esp Med Nucl Imagen Mol 2017. [DOI: 10.1016/j.remnie.2017.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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55
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Neurosarcoidosis and multiple intracerebral hematomas: An unusual clinical presentation. J Neurol Sci 2017; 379:22-24. [PMID: 28716245 DOI: 10.1016/j.jns.2017.05.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Revised: 04/13/2017] [Accepted: 05/15/2017] [Indexed: 11/23/2022]
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Voelkel JE, Loeb J, Rios S, Masoud A. Longitudinally Extensive Spinal Neurosarcoid from the Brainstem to T3 - T4. Kans J Med 2017; 10:17-19. [PMID: 29472960 PMCID: PMC5733406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Jacob E. Voelkel
- University of Missouri-Kansas City School of Medicine, Kansas City, MO
| | - Joseph Loeb
- University of Missouri-Kansas City School of Medicine, Department of Radiology
| | - Salvador Rios
- University of Missouri-Kansas City School of Medicine, Kansas City, MO
| | - Amgad Masoud
- University of Missouri-Kansas City School of Medicine, Department of Internal Medicine
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Abstract
Rheumatic disease represents a broad spectrum of systemic conditions manifested by multisystem involvement and mediated by autoimmunity and inflammation. Their neurological complications may occur at any point in the disease process and are diagnostically challenging. For years central nervous system (CNS) was considered as a system uniquely protected from effects of the immune system because of the blood-brain barrier. Indeed, under physiological conditions immune access to CNS is tightly regulated. Over the past decade, new scientific discoveries highlighted pathways by which immune and neurological systems interact, including a variety of mechanisms controlling permeability of blood-brain barrier, and specific roles that CD4+ and CD8+ T-lymphocytes play in initiation of specific adaptive immune response to neural specific antigens. This leads to release of proinflammatory cytokines (interleukin 1, interleukin 6, and tumor necrosis factor alpha). In addition, B-cells involved in CNS inflammation produce antibodies against membrane bound and soluble antigens. This article describes specific neurological manifestations of the most common autoimmune rheumatic disorders.
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Affiliation(s)
- Svetlana Lvovich
- From the Section of Rheumatology, Department of Pediatrics, St. Christopher's Hospital for Children, Drexel University College of Medicine, Philadelphia, PA.
| | - Donald P Goldsmith
- From the Section of Rheumatology, Department of Pediatrics, St. Christopher's Hospital for Children, Drexel University College of Medicine, Philadelphia, PA
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Jotterand M, Grabherr S, Lobrinus JA, Michaud K. Sudden cardiac death and sarcoidosis of the heart in a young patient. Cardiovasc Pathol 2017; 28:18-20. [PMID: 28282543 DOI: 10.1016/j.carpath.2017.01.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 01/11/2017] [Accepted: 01/11/2017] [Indexed: 11/16/2022] Open
Abstract
Sarcoidosis is a granulomatous disease of unknown etiology affecting any organ, microscopically characterized by noncaseating granulomata. Cardiac involvement in sarcoidosis has been reported. It might be symptomatic or not and even revealed by sudden death. Heart conduction system is rarely investigated at autopsy, even in cases of sudden cardiac death. We present a case of a 32-year-old woman who died suddenly. The examination of the heart conduction system revealed a cardiac sarcoidosis that could explain the sudden death. The review of clinical data of the patient revealed some symptoms consistent/in agreement with this hypothesis. Cardiac sarcoidosis remains a diagnostic challenge and can be easily missed, clinically and pathologically. The retrospective analysis of clinical data and autopsy results of fatal and unusual cases might help to better understand sarcoidosis and its clinical presentations. Examination of the cardiac conduction system is crucial in selected cases of sudden cardiac death.
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Akimoto J, Nagai K, Ogasawara D, Tanaka Y, Izawa H, Kohno M, Uchida K, Eishi Y. Solitary tentorial sarcoid granuloma associated with Propionibacterium acnes infection: case report. J Neurosurg 2016; 127:687-690. [PMID: 27885956 DOI: 10.3171/2016.8.jns16480] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Sarcoidosis is a systemic granulomatous disease with unknown cause, which very rarely occurs exclusively in the central nervous system. The authors performed biopsy sampling of a mass that developed in the left tentorium cerebelli that appeared to be a malignant tumor. The mass was diagnosed as a sarcoid granuloma, which was confirmed with the onset of antibody reaction product against Propionibacterium acnes. Findings suggesting sarcoidosis to be an immune response to P. acnes infection have recently been reported, and they give insight for diagnosis and treatment of this disease. The authors report the possible first case that was confirmed with P. acnes infection in a meningeal lesion in solitary neurosarcoidosis.
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Affiliation(s)
- Jiro Akimoto
- Department of Neurosurgery, Tokyo Medical University; and
| | - Kenta Nagai
- Department of Neurosurgery, Tokyo Medical University; and
| | | | - Yujiro Tanaka
- Department of Neurosurgery, Tokyo Medical University; and
| | - Hitoshi Izawa
- Department of Neurosurgery, Tokyo Medical University; and
| | | | - Keisuke Uchida
- Department of Human Pathology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Yoshinobu Eishi
- Department of Human Pathology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
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Cavernous sinus syndrome due to neurosarcoidosis in adolescence: a diagnosis not to be missed. Neurol Sci 2016; 38:517-519. [PMID: 27882437 DOI: 10.1007/s10072-016-2753-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 10/27/2016] [Indexed: 10/20/2022]
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Ferriby D, de Sèze J. Neurosarcoidosi. Neurologia 2016. [DOI: 10.1016/s1634-7072(16)78803-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Abstract
BACKGROUND Cryptococcal meningitis is an uncommon but severe complication of sarcoidosis. METHODS We present 2 patients with cryptococcal meningitis complicating sarcoidosis and compared findings with 38 cases reported in the literature. RESULTS When analyzing our patients and 38 cases reported in the literature, we found that median age of sarcoidosis patients with cryptococcal meningitis was 39 years (range 30-48); 27 of 33 reported cases (82%) had a history of sarcoidosis. Only 16 of 40 patients (40%) received immunomodulating therapy at the time of diagnosis of cryptococcal meningitis. The diagnosis of cryptococcal meningitis was delayed in 17 of 40 patients (43%), mainly because of the initial suspicion of neurosarcoidosis. Cerebrospinal fluid (CSF) examination showed mildly elevated white blood cell count (range 23-129/mm). Twenty-nine of 32 cases (91%) had a positive CSF culture for Cryptococcus neoformans and 25 of 27 cases (93%) had a positive CSF C neoformans antigen test. CD4 counts were low in all patients in whom counts were performed (84-228/mL). Twelve patients had an unfavorable outcome (32%), of which 7 died (19%) and 24 patients (65%) had a favorable outcome. The rate of unfavorable outcome in patients with a delayed diagnosis was 7 of 17 (41%) compared to 5 of 28 (21%) in patients in whom diagnosis was not delayed. CONCLUSION Cryptococcal meningitis is a rare but life-threatening complication of sarcoidosis. Patients were often initially misdiagnosed as neurosarcoidosis, which resulted in considerable treatment delay and worse outcome. CSF cryptococcal antigen tests are advised in patients with sarcoidosis and meningitis.
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Affiliation(s)
| | | | | | - Matthijs C. Brouwer
- Department of Neurology, Academic Medical Center, Center of Infection and Immunity Amsterdam (CINIMA), Amsterdam, the Netherlands
- Correspondence: Matthijs C. Brouwer, Department of Neurology, Academic Medical Centre, University of Amsterdam, the Netherlands (e-mail: )
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Sarada PP, Sundararajan K. The devil is in the detail: Acute Guillain-Barré syndrome camouflaged as neurosarcoidosis in a critically ill patient admitted to an Intensive Care Unit. Indian J Crit Care Med 2016; 20:238-41. [PMID: 27303139 PMCID: PMC4906336 DOI: 10.4103/0972-5229.180045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Guillain–Barré syndrome (GBS) is an acute demyelinating polyneuropathy, usually evoked by antecedent infection. Sarcoidosis is a multisystem chronic granulomatous disorder with neurological involvement occurring in a minority. We present a case of a 43-year-old Caucasian man who presented with acute ascending polyradiculoneuropathy with a recent diagnosis of pulmonary sarcoidosis. The absence of acute flaccid paralysis excluded a clinical diagnosis of GBS in the first instance. Subsequently, a rapid onset of proximal weakness with multi-organ failure led to the diagnosis of GBS, which necessitated intravenous immunoglobulin and plasmapheresis to which the patient responded adequately, and he was subsequently discharged home. Neurosarcoidosis often masquerades as other disorders, leading to a diagnostic dilemma; also, the occurrence of a GBS-like clinical phenotype secondary to neurosarcoidosis may make diagnosing coexisting GBS a therapeutic challenge. This article not only serves to exemplify the rare association of neurosarcoidosis with GBS but also highlights the need for a high index of clinical suspicion for GBS and accurate history taking in any patient who may present with rapidly progressing weakness to an Intensive Care Unit.
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Clinical and radiological features of extra-pulmonary sarcoidosis: a pictorial essay. Insights Imaging 2016; 7:571-87. [PMID: 27222055 PMCID: PMC4956623 DOI: 10.1007/s13244-016-0495-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 04/07/2016] [Accepted: 04/22/2016] [Indexed: 12/19/2022] Open
Abstract
Abstract The aim of this manuscript is to describe radiological findings of extra-pulmonary sarcoidosis. Sarcoidosis is an immune-mediated systemic disease of unknown origin, characterized by non-caseating epitheliod granulomas. Ninety percent of patients show granulomas located in the lungs or in the related lymph nodes. However, lesions can affect any organ. Typical imaging features of liver and spleen sarcoidosis include visceromegaly, with multiple nodules hypodense on CT images and hypointense on T2-weighted MRI acquisitions. Main clinical and radiological manifestations of renal sarcoidosis are nephrolithiasis, nephrocalcinosis, and acute interstitial nephritis. Brain sarcoidosis shows multiple or solitary parenchymal nodules on MRI that enhance with a ring-like appearance after gadolinium. In spinal cord localization, MRI demonstrates enlargement and hyperintensity of spinal cord, with hypointense lesions on T2-weighted images. Skeletal involvement is mostly located in small bone, showing many lytic lesions; less frequently, bone lesions have a sclerotic appearance. Ocular involvement includes uveitis, conjunctivitis, optical nerve disease, chorioretinis. Erythema nodosum and lupus pernio represent the most common cutaneous manifestations encountered. Sarcoidosis in various organs can be very insidious for radiologists, showing different imaging features, often non-specific. Awareness of these imaging features helps radiologists to obtain the correct diagnosis. Teaching Points • Systemic sarcoidosis can exhibit abdominal, neural, skeletal, ocular, and cutaneous manifestations. • T2 signal intensity of hepatosplenic nodules may reflect the disease activity. • Heerfordt’s syndrome includes facial nerve palsy, fever, parotid swelling, and uveitis. • In the vertebrae, osteolytic and/or diffuse sclerotic lesions can be found. • Erythema nodosum and lupus pernio represent the most common cutaneous manifestations.
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65
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Rovira A, Auger C. Spinal Cord in Multiple Sclerosis: Magnetic Resonance Imaging Features and Differential Diagnosis. Semin Ultrasound CT MR 2016; 37:396-410. [PMID: 27616313 DOI: 10.1053/j.sult.2016.05.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Multiple sclerosis (MS) is an idiopathic inflammatory disorder of the central nervous system that affects not only the brain but also the spinal cord. In the diagnostic and monitoring process of MS, spinal cord magnetic resonance imaging (MRI) is not performed as commonly as brain MRI, mainly because of certain technical difficulties and the increase in total acquisition time. Nonetheless, spinal cord MRI findings are important to establish a prompt accurate diagnosis of MS, impart prognostic information, and provide valuable data for monitoring the disease course in certain cases. In this article, we discuss the technical aspects of spinal cord MRI, the typical MRI features of the spinal cord in MS, the clinical indications for this examination, and the differential diagnosis with other disorders that may produce similar clinical or MRI findings.
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Affiliation(s)
- Alex Rovira
- Department of Radiology, Hospital Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain.
| | - Cristina Auger
- Department of Radiology, Hospital Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain
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Morales H, Betts A. Abnormal Spinal Cord Magnetic Resonance Signal: Approach to the Differential Diagnosis. Semin Ultrasound CT MR 2016; 37:372-83. [PMID: 27616311 DOI: 10.1053/j.sult.2016.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
T2-hyperintense signal abnormalities within the spinal cord on magnetic resonance imaging can evoke a broad differential diagnosis and can present a diagnostic dilemma. Here, we review and provide a succinct and relevant differential diagnosis based on imaging patterns and anatomical or physiopathologic correlation. Clues and imaging pearls are provided focusing on inflammatory, infectious, demyelinating, vascular, and metabolic involvement of the spinal cord.
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Affiliation(s)
- Humberto Morales
- Section of Neuroradiology, University of Cincinnati Medical Center, Cincinnati, OH.
| | - Aaron Betts
- Section of Neuroradiology, University of Cincinnati Medical Center, Cincinnati, OH
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Abstract
The diagnosis of sarcoidosis, a systemic granulomatous disease, is based on a compatible clinical-radiological picture and the histological evidence of noncaseating granulomas. Other diseases mimicking sarcoidosis, mostly infections and other granulomatoses, have to be excluded. There is no single test for sarcoidosis, and the presence of granulomas alone does not establish the diagnosis. Symptoms of sarcoidosis are not specific and can be markedly different according to organ involvement and disease course. Respiratory symptoms and fatigue are the most common symptoms at any stage of disease. Histological confirmation is not needed for Löfgren's or Heerfordt's syndrome and asymptomatic bihilar lymphadenopathy. The radiological staging system is still based on chest radiography, and computed tomography is not mandatory for routine follow-up. (18)F-fluorodeoxyglucose positron emission tomography may be of value in special cases. For assessment of lung involvement and follow-up, pulmonary function tests are necessary with vital capacity being the most important single parameter and diffusion capacity the most sensitive. Bronchoscopy with biopsy is the most common procedure for detection of granulomas, when there is no easier biopsy site like skin or peripheral lymph nodes. Endobronchial ultrasonography-guided transbronchial needle aspiration has replaced mediastinoscopy for evaluation of mediastinal and hilar lymph nodes with a high diagnostic yield. Despite numerous studies, no single biomarker can be reliably used for correct diagnosis or exclusion of sarcoidosis. Genetic testing, despite promising advances, has still not been included in routine care for sarcoidosis patients. The long-term prognosis of sarcoidosis depends on the different organ manifestations: Cardiac or central nervous involvement, together with respiratory complications, is critical. A multidisciplinary approach is necessary for comprehensive care of the sarcoidosis patient.
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68
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Leonhard SE, Fritz D, Eftimov F, van der Kooi AJ, van de Beek D, Brouwer MC. Neurosarcoidosis in a Tertiary Referral Center: A Cross-Sectional Cohort Study. Medicine (Baltimore) 2016; 95:e3277. [PMID: 27057889 PMCID: PMC4998805 DOI: 10.1097/md.0000000000003277] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The aim of this study was to evaluate clinical characteristics, diagnostic strategy, and treatment in patients with neurosarcoidosis in a tertiary referral centre.In a cross-sectional study, we included all patients with neurosarcoidosis treated at our tertiary referral center between September 2014 and April 2015.We identified 52 patients, among them 1 patient was categorized as having definite neurosarcoidosis, 37 probable neurosarcoidosis, and 14 possible neurosarcoidosis. Neurologic symptoms were the first manifestation of sarcoidosis in 37 patients (71%). Chronic aseptic meningitis was the most common presentation (19/52 patients [37%]), followed by cranial neuropathy (16/52 patients [31%]). Serum angiotensin-converting enzyme and lysozyme levels were elevated in 18 of 41 (44%) and 12 of 26 cases (46%). Pulmonary or lymph node sarcoidosis was identified by chest X-ray in 21 of 39 cases (54%) and by computed tomography of the chest in 25 of 31 cases (81%); Fluorodeoxyglucose-Positron emission tomography showed signs of sarcoidosis in 15 of 19 cases (79%). Thirty-one of the 46 cases receiving treatment (67%) improved, 13 cases (28%) stabilized, and 2 cases (4%) deteriorated. First-line treatment with corticosteroids resulted in satisfactory reduction of symptoms in 21 of 43 patients (49%). Seventeen patients (33%) needed second-line cytostatic treatment, and 10 patients (19%) were treated with tumor necrosis factor-α inhibitors.The majority of patients with neurosarcoidosis present with chronic meningitis without a history of systemic sarcoidosis. The diagnosis can be difficult to make because of the poor sensitivity of most diagnostic tests. Half of patients had a satisfactory reduction of symptoms on first-line therapy.
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Affiliation(s)
- Sonja E Leonhard
- From the Academic Medical Center, Center of Infection and Immunity Amsterdam (CINIMA), Department of Neurology (SEL, DF, FE, AJV, DV, MCB), Amsterdam, the Netherlands
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Durel CA, Marignier R, Maucort-Boulch D, Iwaz J, Berthoux E, Ruivard M, André M, Le Guenno G, Pérard L, Dufour JF, Turcu A, Antoine JC, Camdessanche JP, Delboy T, Sève P. Clinical features and prognostic factors of spinal cord sarcoidosis: a multicenter observational study of 20 BIOPSY-PROVEN patients. J Neurol 2016; 263:981-990. [PMID: 27007482 DOI: 10.1007/s00415-016-8092-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 03/07/2016] [Accepted: 03/08/2016] [Indexed: 11/30/2022]
Abstract
Sarcoidosis of the spinal cord is a rare disease. The aims of this study are to describe the features of spinal cord sarcoidosis (SCS) and identify prognostic markers. We analyzed 20 patients over a 20-year period in 8 French hospitals. There were 12 men (60 %), mostly Caucasian (75 %). The median ages at diagnosis of sarcoidosis and myelitis were 34.5 and 37 years, respectively. SCS revealed sarcoidosis in 12 patients (60 %). Eleven patients presented with motor deficit (55 %) and 9 had sphincter dysfunction (45 %). The median initial Edmus Grading Scale (EGS) score was 2.5. The cerebrospinal fluid (CSF) showed elevated protein level (median: 1.00 g/L, interquartile range (IQR) 0.72-1.97), low glucose level (median 2.84 mmol/L, IQR 1.42-3.45), and elevated white cell count (median 22/mm(3), IQR 6-45). The cervical and thoracic cords were most often affected (90 %). All patients received steroids and an immunosuppressive drug was added in 10 cases (50 %). After a mean follow-up of 52.1 months (range 8-43), 18 patients had partial response (90 %), 7 displayed functional impairment (35 %), and the median final EGS score was 1. Six patients experienced relapse (30 %). There was an association between the initial and the final EGS scores (p = 0.006). High CSF protein level showed a trend toward an association with relapse (p = 0.076). The spinal cord lesion was often the presenting feature of sarcoidosis. Most patients experienced clinical improvement with corticosteroids and/or immunosuppressive treatment. The long-term functional prognosis was correlated with the initial severity.
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Affiliation(s)
- Cécile-Audrey Durel
- Département de Médicine Interne, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 69004, Lyon, France. .,Université de Lyon, Université Lyon 1, 69100, Villeurbanne, France.
| | - Romain Marignier
- Département de Neurologie, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, 69500, Bron, France
| | - Delphine Maucort-Boulch
- Université de Lyon, Université Lyon 1, 69100, Villeurbanne, France.,Service de Biostatistique, Hospices Civils de Lyon, 69003, Lyon, France.,CNRS UMR 555, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique Santé, 69100, Villeurbanne, France
| | - Jean Iwaz
- Université de Lyon, Université Lyon 1, 69100, Villeurbanne, France.,Service de Biostatistique, Hospices Civils de Lyon, 69003, Lyon, France.,CNRS UMR 555, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique Santé, 69100, Villeurbanne, France
| | - Emilie Berthoux
- Département de Médicine Interne, CH Saint Luc Saint Joseph, 69007, Lyon, France
| | - Marc Ruivard
- Département de Médecine Interne, CHU de Clermont-Ferrand, CHU Estaing, 63003, Clermont-Ferrand, France
| | - Marc André
- Service de Médecine Interne, CHU Clermont-Ferrand, Hôpital Gabriel Montpied, 63003, Clermont-Ferrand, France
| | - Guillaume Le Guenno
- Département de Médecine Interne, CHU de Clermont-Ferrand, CHU Estaing, 63003, Clermont-Ferrand, France
| | - Laurent Pérard
- Département de Médecine Interne, Hôpital Edouard Herriot, Hospices Civils de Lyon, 69008, Lyon, France
| | - Jean-François Dufour
- Département de Médecine Interne, Centre hospitalier Fleyriat, 01012, Bourg-en-Bresse, France
| | - Alin Turcu
- Département de Médecine Interne et Maladies Systémiques, CHU Dijon, 21079, Dijon, France
| | - Jean-Christophe Antoine
- Département de Neurologie, CHU de Saint-Etienne, Hôpital Nord, 42055, Saint Etienne Cedex 022, France
| | | | - Thierry Delboy
- Département de Médecine Interne, CH Montluçon, 03100, Montluçon, France
| | - Pascal Sève
- Département de Médicine Interne, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 69004, Lyon, France.,Université de Lyon, Université Lyon 1, 69100, Villeurbanne, France
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Boudreault K, Durand ML, Rizzo JF. Investigation-Directed Approach to Inflammatory Optic Neuropathies. Semin Ophthalmol 2016; 31:117-30. [DOI: 10.3109/08820538.2015.1114835] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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71
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Williams T, Marta M, Giovannoni G. IgG4-related disease: a rare but treatable cause of refractory intracranial hypertension. Pract Neurol 2015; 16:235-9. [DOI: 10.1136/practneurol-2015-001275] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2015] [Indexed: 12/24/2022]
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Touati N, Mansour M, Bedoui I, Kacem A, Derbali H, Riahi A, Messelmani M, Zaouali J, Fekih-Mrissa N, Mrissa R. [Neurologic manifestations of sarcoidosis: A study of 18 cases]. Rev Neurol (Paris) 2015; 171:773-81. [PMID: 26648345 DOI: 10.1016/j.neurol.2015.07.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 07/13/2015] [Accepted: 07/22/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Sarcoidosis is a multisystemic granulomatous disease of unknown aetiology. Neurologic manifestations are found in 5 to 10% of cases. PATIENTS AND METHODS We conducted a retrospective study over 6-year period including 18 patients diagnosed with neurosarcoidosis in the Neurologic department of the Military Hospital of Instruction of Tunis. Clinical, radiological, therapeutic features and outcome were studied. RESULTS The mean age was 43.44 years. Neurologic signs were the first symptom in 10 cases. Peripheral nervous system impairment was often found. Meningitis was noted in 8 cases. Biological tests are not contributive for the diagnosis. The brain magnetic resonance imaging was pathologic in 10 cases. Corticosteroids were administrated in the majority of cases. Eight patients did not show any sign of improvement. Ten cases improved with treatment. DISCUSSION AND CONCLUSION Diagnosis of neurosarcoidosis is difficult because of its clinical and radiological polymorphism. It is based on a clinical history suggestive of neurosarcoidosis, laboratory, imaging and histological studies.
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Affiliation(s)
- N Touati
- Service de neurologie, hôpital militaire principal d'instruction de Tunis, Mont Fleury, 1008 Tunis, Tunisie.
| | - M Mansour
- Service de neurologie, hôpital militaire principal d'instruction de Tunis, Mont Fleury, 1008 Tunis, Tunisie
| | - I Bedoui
- Service de neurologie, hôpital militaire principal d'instruction de Tunis, Mont Fleury, 1008 Tunis, Tunisie
| | - A Kacem
- Service de médecine, hôpital régional de Jendouba, avenue de l'UMA 8100, Jendouba, Tunisie
| | - H Derbali
- Service de neurologie, hôpital militaire principal d'instruction de Tunis, Mont Fleury, 1008 Tunis, Tunisie
| | - A Riahi
- Service de neurologie, hôpital militaire principal d'instruction de Tunis, Mont Fleury, 1008 Tunis, Tunisie
| | - M Messelmani
- Service de neurologie, hôpital militaire principal d'instruction de Tunis, Mont Fleury, 1008 Tunis, Tunisie
| | - J Zaouali
- Service de neurologie, hôpital militaire principal d'instruction de Tunis, Mont Fleury, 1008 Tunis, Tunisie
| | - N Fekih-Mrissa
- Service d'hématologie, hôpital militaire principal d'instruction de Tunis, Mont Fleury, 1008 Tunis, Tunisie
| | - R Mrissa
- Service de neurologie, hôpital militaire principal d'instruction de Tunis, Mont Fleury, 1008 Tunis, Tunisie
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Tana C, Wegener S, Borys E, Pambuccian S, Tchernev G, Tana M, Giamberardino MA, Silingardi M. Challenges in the diagnosis and treatment of neurosarcoidosis. Ann Med 2015; 47:576-91. [PMID: 26469296 DOI: 10.3109/07853890.2015.1093164] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The diagnosis and treatment of neurosarcoidosis can be very challenging for several reasons. It affects clinically 5%-10% of sarcoidosis patients, but can be found in up to 25% of autopsies. These data reveal that a high percentage of asymptomatic or misdiagnosed cases can be missed at an initial diagnostic approach. Clinical and imaging findings are often non-specific since they can be found in a large number of neurological disorders. Histopathology can also be confounding if not performed by an expert pathologist and not placed in an appropriate clinical context. In this review, we discuss clinical features, laboratory findings, imaging, and histology of neurosarcoidosis, and we report current evidence regarding drug therapy. We conclude that a correct diagnostic approach should include a multidisciplinary evaluation involving clinicians, radiologists, and pathologists and that future studies should evaluate the genetic signature of neurosarcoidosis as they could be helpful in the assessment of this uncommon disease. With head-to-head comparisons of medical treatment for neurosarcoidosis still lacking due to the rarity of the disease and an increasing number of immunomodulating therapies at hand, novel therapeutic approaches are to be expected within the next few years.
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Affiliation(s)
- Claudio Tana
- a Internal Medicine Unit , Guastalla Hospital, AUSL Reggio Emilia , Reggio Emilia , Italy
| | - Susanne Wegener
- b Department of Neurology , University Hospital Zurich and University of Zurich , Zurich , Switzerland
| | - Ewa Borys
- c Department of Pathology , Loyola University Medical Center and Stritch School of Medicine, Loyola University Chicago , Maywood , Illinois , USA
| | - Stefan Pambuccian
- c Department of Pathology , Loyola University Medical Center and Stritch School of Medicine, Loyola University Chicago , Maywood , Illinois , USA
| | - Georgi Tchernev
- d Polyclinic for Dermatology and Venereology and Medical Faculty , University Hospital Lozenetz and Sofia University , Sofia , Bulgaria
| | - Marco Tana
- e Department of Medicine and Science of Aging , "G. d'Annunzio" University , Chieti , Italy
| | | | - Mauro Silingardi
- a Internal Medicine Unit , Guastalla Hospital, AUSL Reggio Emilia , Reggio Emilia , Italy
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