Central nervous system sarcoidosis

Neurosarcoïdose : état des connaissances

The origins of neurosarcoidosis, a multisystemic granulomatous disease, remain unknown. Nervous system localizations remain rare, but severe. Lymphocytic meningitis, psychiatric disorders, diabetes insipidus and cranial nerve palsy are the most frequent signs. Cerebral fluid test and cervical medullar and cerebral MRI with gadolinium have to be performed first. In some cases, histological evidence of granuloma have to be obtained with neuromuscular, meningeal or cerebral biopsies. Functional impairment and life-threatening conditions require early corticosteroid therapy. In worsening cases or in the event of no therapeutic response or poor tolerance to corticosteroids, other immunosuppressive agents should be associated. Maintenance therapy and most often life long maintenance therapy allow a continuous success while avoiding relapse.

Diagnosis and management of neurosarcoidosis

Sarcoidosis is a multisystemic disorder characterised by the presence of multiple noncaseating granulomas. Clinically recognisable nervous system involvement occurs in 5-16% of patients with sarcoidosis. However, the incidence of subclinical neurosarcoidosis may be higher. The following article presents a review of the disease, including its pathophysiology, clinical and radiological characteristics and treatment. Neurosarcoidosis should be included in the differential diagnosis of infectious and noninfectious neurological syndromes.

The occurrence of organic disease of possible or probable aetiological significance in a population of 268 cases of first episode schizophrenia

In a sample of 268 cases of first-episode schizophrenia, 15 patients were found to have organic disease which appeared relevant to the mental state. There were three cases of syphilis, two cases of sarcoidosis, three of alcohol excess and two of drug abuse. There was one case each of carcinoma of the lung, autoimmune multisystem disease, cerebral cysticercosis, thyroid disease and previous head injury. In this series, identified organic disease was associated with less than 6% of cases of schizophrenia.

Recent research developments in consultation-liaison psychiatry

With the major changes in health care and general hospital practice in the last decade, practice and research in consultation and liaison psychiatry have also changed dramatically. The authors present a selected review of recent advances and implications for five important topics in consultation-liaison research: diagnosis, disease mechanisms, biologic treatments, health services, and psychosocial treatments for medical disorders.

Neurosarcoidosis: clinical presentations and course in 50 patients

Fifty consecutive patients with neurosarcoidosis were evaluated retrospectively. Sarcoidosis presented first with neurologic signs in 24 patients (48%), but systemic symptoms developed later in all but five. Main neurologic involvements were central nervous system lesions in 33 patients (66%), cranial nerve paresis in 12 (24%), and peripheral nerve lesions in five patients (10%). Seventeen patients (34%) had more than one type of neurologic involvement. Routine cerebrospinal fluid (CSF) parameters showed unspecific abnormalities in 35 patients (70%). CSF angiotensin converting enzyme was elevated in 18 of 31 patients (58%). Brain computerized tomography was abnormal in 13 of 32 patients (41%). Visual and brainstem evoked potentials were abnormal in ten (43%) and eight (35%) of 23 patients, respectively, suggesting subclinical lesions in 13 patients. Neurologic signs improved in 24 patients (48%), were stable in 11 (22%), and progressed in 15 patients (30%). Six patients died. Cranial nerve lesions improved most often. Course of neurologic involvements was similar in acute or subacute and chronic sarcoidosis. The effect of steroid treatment was inconsistent.