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Machado VS, Silva Junior NA, Queiroz LS, Reis F, Silva DDS, Bueno FF, Coan AC. Central nervous system involvement in sarcoidosis. Radiol Bras 2015; 48:334-5. [PMID: 26543288 PMCID: PMC4633081 DOI: 10.1590/0100-3984.2014.0113] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
| | | | | | - Fabiano Reis
- Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brazil
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Abstract
Corticosteroids are the drug of choice for the treatment of sarcoidosis. Because the natural course of sarcoidosis may be self-limiting and/or cause no long-term harm, treatment is not mandatory. Corticosteroids are usually effective for all forms of sarcoidosis, and they work quickly. However, because of the potential toxicities of corticosteroids, alternative medications often need to be considered. Efforts should be made to minimize the corticosteroid dose while keeping the risk of toxicity as low as possible. This article outlines the indications for corticosteroid therapy for sarcoidosis, discusses various dosing regimens, and suggests when alternative corticosteroid agents should be considered.
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Lareau CA, Adrianto I, Levin AM, Iannuzzi MC, Rybicki BA, Montgomery CG. Fine mapping of chromosome 15q25 implicates ZNF592 in neurosarcoidosis patients. Ann Clin Transl Neurol 2015; 2:972-7. [PMID: 26478897 PMCID: PMC4603380 DOI: 10.1002/acn3.229] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 06/24/2015] [Accepted: 07/04/2015] [Indexed: 12/31/2022] Open
Abstract
Neurosarcoidosis is a clinical subtype of sarcoidosis characterized by the presence of granulomas in the nervous system. Here, we report a highly significant association with a variant (rs75652600, P = 3.12 × 10−8, odds ratios = 4.34) within a zinc finger gene, ZNF592, from an imputation-based fine-mapping study of the chromosomal region 15q25 in African-Americans with neurosarcoidosis. We validate the association with ZNF592, a gene previously shown to cause cerebellar ataxia, in a cohort of European-Americans with neurosarcoidosis by uncovering low-frequency variants with a similar risk effect size (chr15:85309284, P = 0.0021, odds ratios = 5.36).
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Affiliation(s)
- Caleb A Lareau
- Arthritis and Clinical Immunology Research Program, Oklahoma Medical Research Foundation Oklahoma City, Oklahoma ; Departments of Biostatistics, Harvard University Cambridge, Massachusetts
| | - Indra Adrianto
- Arthritis and Clinical Immunology Research Program, Oklahoma Medical Research Foundation Oklahoma City, Oklahoma
| | - Albert M Levin
- Department of Public Health Services, Henry Ford Health System Detroit, Michigan ; Center for Bioinformatics, Henry Ford Health System Detroit, Michigan
| | | | - Benjamin A Rybicki
- Department of Public Health Services, Henry Ford Health System Detroit, Michigan
| | - Courtney G Montgomery
- Arthritis and Clinical Immunology Research Program, Oklahoma Medical Research Foundation Oklahoma City, Oklahoma
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Pegat B, Drapier S, Morandi X, Edan G. Spinal cord hemorrhage in a patient with neurosarcoidosis on long-term corticosteroid therapy: case report. BMC Neurol 2015. [PMID: 26224095 PMCID: PMC4520197 DOI: 10.1186/s12883-015-0373-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Central nervous system bleeding is a rare complication of neurosarcoidosis: only 18 cases of spontaneous cerebral hematoma have been reported. We present the first recorded case of spinal cord hemorrhage in neurosarcoidosis. CASE PRESENTATION A 48-year-old Caucasian woman had relapsing neurosarcoidosis for 5 years, with inflammatory spinal and cerebral lesions. While on 20 mg corticosteroids, she experienced subacute paraparesia with right leg pain. A spine MRI revealed a low thoracic hematomyelia at the T10-T11 level. Despite high doses of corticosteroids, her condition continued to worsen. Surgical evacuation of the hematoma was performed 10 days after the onset of bleeding, and she partially recovered. CONCLUSION This report highlights the possibility of spinal cord hemorrhage secondary to sarcoid vasculitis. The patient improved after surgical evacuation of the intramedullary hematoma. Immuno-modulating agents must be envisaged in severe neurosarcoidosis, to prevent complications.
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Affiliation(s)
- Benoit Pegat
- Department of Neurology, Pontchaillou Hospital, Rennes University Hospital, Rennes, France.
| | - Sophie Drapier
- Department of Neurology, Pontchaillou Hospital, Rennes University Hospital, Rennes, France.
| | - Xavier Morandi
- Department of Neurosurgery, Pontchaillou Hospital, Rennes University Hospital, Rennes, France.
| | - Gilles Edan
- Department of Neurology, Pontchaillou Hospital, Rennes University Hospital, Rennes, France.
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Oumerzouk J, Raggabi A, Hssaini Y, Bourazza A. [Tumor-like neurosarcoidosis: About one case]. Presse Med 2015; 44:684-7. [PMID: 25960441 DOI: 10.1016/j.lpm.2015.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 01/23/2015] [Accepted: 01/29/2015] [Indexed: 11/16/2022] Open
Affiliation(s)
- Jawad Oumerzouk
- Service de neurologie, hôpital militaire d'instruction Mohamed V, 10100 Rabat, Maroc.
| | - Amine Raggabi
- Service de neurologie, hôpital militaire d'instruction Mohamed V, 10100 Rabat, Maroc
| | - Yahya Hssaini
- Service de neurologie, hôpital militaire d'instruction Mohamed V, 10100 Rabat, Maroc
| | - Ahmed Bourazza
- Service de neurologie, hôpital militaire d'instruction Mohamed V, 10100 Rabat, Maroc
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Vertigo as a predominant manifestation of neurosarcoidosis. Case Rep Med 2015; 2015:397046. [PMID: 25922606 PMCID: PMC4398954 DOI: 10.1155/2015/397046] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Accepted: 03/26/2015] [Indexed: 12/03/2022] Open
Abstract
Sarcoidosis is a granulomatous disease of unknown etiology that affects multiple organ systems. Neurological manifestations of sarcoidosis are less common and can include cranial neuropathies and intracranial lesions. We report the case of a 21-year-old man who presented with vertigo and uveitis. Extensive workup including brain imaging revealed enhancing focal lesions. A lacrimal gland biopsy confirmed the diagnosis of sarcoidosis. The patient was initially treated with prednisone, which did not adequately control his symptoms, and then was switched to methotrexate with moderate symptomatic improvement. Our patient had an atypical presentation with vertigo as the predominant manifestation of sarcoidosis. Patients with neurosarcoidosis typically present with systemic involvement of sarcoidosis followed by neurologic involvement. Vertigo is rarely reported as an initial manifestation. This case highlights the importance of consideration of neurosarcoidosis as an entity even in patients that may not have a typical presentation or systemic involvement of disease.
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A case of sarcoidosis of the central nervous system and orbita. Case Rep Med 2015; 2015:403459. [PMID: 25810722 PMCID: PMC4355551 DOI: 10.1155/2015/403459] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 02/10/2015] [Accepted: 02/15/2015] [Indexed: 11/23/2022] Open
Abstract
Sarcoidosis is a multisystemic disease characterized by granulomatous inflammation. Lung or lymph node involvement is common. We present a rare case of sarcoidosis that began with orbital involvement, and a month later, due to insufficient treatment, it involved the central nervous system. A 49-year-old female patient began suffering from swelling in her right eye, redness, ptosis, and limited eye movements two months ago. Gadolinium-enhanced orbital magnetic resonance imaging showed thickening of the lacrimal gland and the right medial rectus muscle. After three weeks of local antibiotic and steroid treatments, her symptoms were resolved. One month ago, the patient reported sudden weakness in her right arm and leg. After laboratory tests and imaging studies, the patient was diagnosed with probable neurosarcoidosis using the Zajicek criteria and treated with prednisone (1 mg/kg/day). Although sarcoidosis frequently presents with lung and lymph node involvement, it is rarely accompanied by orbital involvement. Patients with orbital symptoms may receive a late diagnosis and insufficient central nervous system treatment. Involvement of the central nervous system in sarcoidosis leads to high morbidity and mortality rates. Therefore, early diagnosis and treatment are very important.
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58
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Pichler MR, Flanagan EP, Aksamit AJ, Leavitt JA, Salomão DR, Keegan BM. Conjunctival biopsy to diagnose neurosarcoidosis in patients with inflammatory nervous system disease of unknown etiology. Neurol Clin Pract 2015; 5:216-223. [PMID: 29443212 DOI: 10.1212/cpj.0000000000000133] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Neurosarcoidosis mimics many neurologic diseases and poses a major diagnostic challenge. Blind conjunctival biopsy is often used to help diagnose neurosarcoidosis when biopsy of affected nervous system tissue is not feasible. While this test is relatively inexpensive and well-tolerated, the diagnostic yield in patients with inflammatory nervous system disease of unknown etiology remained uncertain. We evaluated 440 patients who underwent conjunctival biopsy due to concern for neurosarcoidosis. Only a small minority of patients (3%) had positive conjunctival biopsies consistent with sarcoidosis, and some patients (1%) with positive biopsies were found to have a cause for their neurologic disease other than neurosarcoidosis. Many patients (14%) had negative conjunctival biopsies but were later confirmed to have neurosarcoidosis after additional evaluations. This study demonstrates that conjunctival biopsy has a low diagnostic yield for neurosarcoidosis in patients with inflammatory nervous system disease and suggests that alternative diagnostic means should be pursued.
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Affiliation(s)
- Michael R Pichler
- Departments of Neurology (MRP, EPF, AJA, BMK), Ophthalmology (JAL, DRS), and Pathology (DRS), Mayo Clinic, Rochester, MN
| | - Eoin P Flanagan
- Departments of Neurology (MRP, EPF, AJA, BMK), Ophthalmology (JAL, DRS), and Pathology (DRS), Mayo Clinic, Rochester, MN
| | - Allen J Aksamit
- Departments of Neurology (MRP, EPF, AJA, BMK), Ophthalmology (JAL, DRS), and Pathology (DRS), Mayo Clinic, Rochester, MN
| | - Jacqueline A Leavitt
- Departments of Neurology (MRP, EPF, AJA, BMK), Ophthalmology (JAL, DRS), and Pathology (DRS), Mayo Clinic, Rochester, MN
| | - Diva R Salomão
- Departments of Neurology (MRP, EPF, AJA, BMK), Ophthalmology (JAL, DRS), and Pathology (DRS), Mayo Clinic, Rochester, MN
| | - B Mark Keegan
- Departments of Neurology (MRP, EPF, AJA, BMK), Ophthalmology (JAL, DRS), and Pathology (DRS), Mayo Clinic, Rochester, MN
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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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60
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Overview of neurosarcoidosis: recent advances. J Neurol 2014; 262:258-67. [PMID: 25194844 PMCID: PMC4330460 DOI: 10.1007/s00415-014-7482-9] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 08/26/2014] [Accepted: 08/26/2014] [Indexed: 01/10/2023]
Abstract
Sarcoidosis (SA) is a granulomatous, multisystem disease of unknown etiology. Most often the disease affects lungs and mediastinal lymph nodes, but it may occur in other organs. Neurosarcoidosis (NS) more commonly occurs with other sarcoidosis forms, in 1 % of cases it involves only nervous system. Symptomatic NS occurs but on autopsy study up to 25 % of cases are confirmed. NS can affect central nervous system: the brain, spinal cord and peripheral nerves, and muscles. The diagnosis of neurosarcoidosis facilitates diagnostic criteria: histopathological, imaging and cerebrospinal fluid examination, and clinical symptoms. At present, there are no set standards for treatment of patients suffering from NS. Early therapy of symptomatic patients is recommended. Corticosteroids still are the first line of treatment for NS patients. In cases of steroids resistance, lack of their effectiveness or existence of contraindication to their use, immunosuppressant treatment is recommended. The latest NS algorithm with immunosuppressive treatment is discussed.
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Abstract
Sarcoidosis is a chronic inflammatory disorder that has the potential to affect multiple organs, including the skin. Its cutaneous manifestations are varied and can provide clues to underlying systemic manifestations. Unfortunately, they also can be disfiguring. Therapy is usually directed at the organ system most severely affected, which often may help cutaneous disease. However, cutaneous disease may be recalcitrant to treatment directed at extracutaneous disease, or it may be severe enough to require targeted therapy. This article focuses on the dermatologist's role in recognizing and diagnosing cutaneous sarcoidosis, evaluating patients for systemic disease involvement, and treating the skin manifestations of sarcoidosis.
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Affiliation(s)
- Karolyn A Wanat
- Department of Dermatology, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA
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62
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Eklund A, du Bois RM. Approaches to the treatment of some of the troublesome manifestations of sarcoidosis. J Intern Med 2014; 275:335-49. [PMID: 24433397 DOI: 10.1111/joim.12198] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Sarcoidosis can be a major therapeutic challenge given its multiplicity of clinical presentations, variable combination of organ involvement and severity, and unpredictable longitudinal behaviour. Six manifestations of sarcoidosis are especially difficult to manage because of (i) an incomplete knowledge of causation - fatigue and small fibre neuropathy, (ii) the rare occurrence in sarcoidosis - intra-abdominal complications or (iii) the potentially life-threatening consequences in some patients - neurological disease, pulmonary hypertension and hypercalcaemia. In none of these situations have a prospective, double-blind, placebo-controlled trial of any therapy been conducted. Despite this absence of any firm evidence base to support therapeutic recommendations, these six entities can be extremely problematic for the practising clinician. It is for this reason that we have focused in this review on these six disease manifestations and provided a synopsis of each problem together with suggested treatment approaches, based on an analysis of the current literature.
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Affiliation(s)
- A Eklund
- Department of Medicine, Karolinska University Hospital, Karolinska Institutet and Centre for Molecular Medicine, Stockholm, Sweden
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63
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Multiple cranial nerve palsies as the first presentation of sarcoidosis. Case Rep Otolaryngol 2014; 2014:592510. [PMID: 24790763 PMCID: PMC3984804 DOI: 10.1155/2014/592510] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 02/27/2014] [Indexed: 11/18/2022] Open
Abstract
Sarcoidosis is a disease process which predominantly affects the lungs but can involve virtually any organ in the human body. Neurosarcoidosis is a rare manifestation which can present in a variety of ways. There is no single diagnostic test for sarcoidosis; hence, the diagnosis is based on combined clinical, laboratorial, and radiological grounds. We describe a rare case where a patient presented with dysphagia, hoarseness, hearing loss, and unsteadiness.
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Quenardelle V, Benmekhbi M, Aupy J, Dalvit C, Hirsch E, Benoilid A. Neurosarcoïdose de présentation atypique. Rev Med Interne 2013; 34:776-9. [DOI: 10.1016/j.revmed.2013.02.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Revised: 01/26/2013] [Accepted: 02/18/2013] [Indexed: 01/19/2023]
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65
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Fortes GCC, Oliveira MCB, Lopes LCG, Tomikawa CS, Lucato LT, Castro LHM, Nitrini R. Rapidly progressive dementia due to neurosarcoidosis. Dement Neuropsychol 2013; 7:428-434. [PMID: 29213869 PMCID: PMC5619506 DOI: 10.1590/s1980-57642013dn74000012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Rapidly progressive dementia (RPD) is typically defined as a cognitive decline
progressing to severe impairment in less than 1-2 years, typically within weeks
or months. Accurate and prompt diagnosis is important because many conditions
causing RPD are treatable. Neurosarcoidosis is often cited as an unusual
reversible cause of RPD.
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Affiliation(s)
| | | | - Laura Cardia G Lopes
- Department of Neurology, Faculdade de Medicina da Universidade de São Paulo, São Paulo SP, Brazil
| | - Camila S Tomikawa
- Department of Pathology, Faculdade de Medicina da Universidade de São Paulo, São Paulo SP, Brazil
| | - Leandro T Lucato
- Department of Radiology, Faculdade de Medicina da Universidade de São Paulo, São Paulo SP, Brazil
| | - Luiz Henrique M Castro
- Department of Neurology, Faculdade de Medicina da Universidade de São Paulo, São Paulo SP, Brazil
| | - Ricardo Nitrini
- Department of Neurology, Faculdade de Medicina da Universidade de São Paulo, São Paulo SP, Brazil
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Abstract
OPINION STATEMENT Neurosarcoidosis can involve either the central nervous system (CNS), the peripheral nervous system (PNS), or both. The clinical manifestations are varied and include cranial neuropathy, aseptic meningitis, hydrocephalus, headache, seizure, neuropsychiatric symptoms, neuroendocrine dysfunction, myelopathy, and peripheral neuropathy. Neurologic problems that develop in sarcoidosis patients should not be assumed to represent neurosarcoidosis, as they are often attributable to another cause. The diagnostic work up of neurosarcoidosis should include an evaluation for potential extra-neural involvement and histologic confirmation of sarcoidosis. If there is no appropriate extra-neurologic organ for biopsy, a biopsy from involved neural tissue needs to be considered. Biopsy of the dura and leptomeninges is less invasive than biopsy of the brain or spinal cord parenchyma. Gadolinium-enhanced magnetic resonance imaging (MRI) of the brain and spinal cord is the most sensitive test for neurosarcoidosis, while the diagnostic specificity of cerebrospinal fluid (CSF) analysis is limited. Corticosteroids are the mainstay of treatment for neurosarcoidosis. In general, oral corticosteroids are used for mild to moderate cases, while high-dose intravenous methylprednisolone is used in severe cases or refractory cases that fail to respond to oral corticosteroids. Immunomodulating and cytotoxic agents are often required for steroid-refractory neurosarcoidosis or for patients who develop significant corticosteroid adverse effects. Methotrexate is used as a first-line corticosteroid sparing agent. Tumor necrosis factor-alpha inhibitors, including infliximab, are effective for refractory neurosarcoidosis. Cyclophosphamide is also used for refractory neurosarcoidosis patients, but, because of the drug's significant toxicity, it is usually reserved for severe cases that have failed oral therapies when tumor necrosis factor alpha antagonists cannot be obtained. In addition to anti-granulomatous therapy, treatment is frequently required for neurosarcoidosis-associated conditions, such as epilepsy and neuroendocrine dysfunction. Surgical intervention is indicated for life threatening complications such as hydrocephalus, steroid-refractory spinal cord compression, or mass lesions causing increased intracranial pressure.
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Affiliation(s)
- Kenkichi Nozaki
- Division of Neurology, Department of Neurosciences, Medical University of South Carolina, 96 Jonathan Lucas Street, Suite 301 CSB, Charleston, SC, 29425, USA,
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Cunha BA. The clinical and laboratory diagnosis of acute meningitis and acute encephalitis. ACTA ACUST UNITED AC 2013; 7:343-64. [PMID: 23721048 DOI: 10.1517/17530059.2013.804508] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Acute bacterial meningitis (ABM) is a life-threatening infectious disease requiring prompt antimicrobial therapy. ABM must be differentiated from systemic disorders with CNS manifestations that may mimic ABM. ABM should also be differentiated from acute meningoencephalitis (AME) and acute viral encephalitis (AVE). Nonviral causes of AME are treatable. Among the causes of AVE, Herpes simplex encephalitis (HSE) is treatable. This article reviews the clinical diagnostic approach to ABM, AME and AVE. AREAS COVERED The differential diagnostic (DDx) approach to ABM, AME and AVE is based on clinical and laboratory findings. A specific pathogen diagnosis is based on serum/cerebrospinal fluid (CSF) tests. This overview presents the diagnostic approach to ABM, AME and AVE in normal hosts (excluding brain abscesses and chronic CNS infections). EXPERT OPINION It is time critical to diagnose ABM and begin empiric antimicrobial therapy based on the known/most likely pathogen. The diagnosis of ABM depends on clinical features and the CSF profile. The CSF Gram stain and CSF lactic acid (LA) levels provide the most rapid, reliable and cost-effective tests to diagnose ABM. CSF LA levels are also the best way to diagnose partially treated acute bacterial meningitis (PTABM). In those cases of AME/AVE due to viruses with a CSF profile mimicking ABM, for example, HSE, unelevated CSF LA levels rapidly/reliably rule out ABM as a diagnostic possibility.
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Affiliation(s)
- Burke A Cunha
- Winthrop-University Hospital, Infectious Disease Division, Mineola, NY, USA.
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69
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Kiesmann M, Clere R, de Petigny X, Vogel T, Kaltenbach G. [Dementia as the presenting manifestation of sarcoidosis: diagnosis and discussion]. Rev Neurol (Paris) 2013; 169:524-6. [PMID: 23523019 DOI: 10.1016/j.neurol.2012.10.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Revised: 10/01/2012] [Accepted: 10/05/2012] [Indexed: 11/30/2022]
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Bodaghi B, Touitou V, Fardeau C, Chapelon C, LeHoang P. Ocular sarcoidosis. Presse Med 2012; 41:e349-54. [PMID: 22595776 DOI: 10.1016/j.lpm.2012.04.004] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Accepted: 04/03/2012] [Indexed: 11/19/2022] Open
Affiliation(s)
- Bahram Bodaghi
- University of Pierre-and-Marie-Curie, Pitié-Salpêtrière Hospital, DHU Vision and Handicaps, Department of Ophthalmology, 75013 Paris, France.
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71
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Valeyre D, Humbert M. Everything you always wanted to know about sarcoidosis… but were afraid to ask. Presse Med 2012; 41:e273-4. [DOI: 10.1016/j.lpm.2012.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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