1
|
Sciacca G, Nicoletti A, Fermo SL, Mostile G, Giliberto C, Zappia M. Looks can be deceiving: three cases of neurological diseases mimicking Guillain-Barrè syndrome. Neurol Sci 2015; 37:541-5. [PMID: 26707616 DOI: 10.1007/s10072-015-2450-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 12/14/2015] [Indexed: 11/25/2022]
Abstract
Guillain-Barrè syndrome (GBS) is an acute, paralyzing, inflammatory peripheral nerve disease, featured by monophasic disease course, symmetrical limb weakness and areflexia. Several pathologies can mimic the clinical presentation of GBS, making hard the differential diagnosis for patients complaining of acute flaccid paralysis. In this paper we describe three cases of different neurological diseases presenting with acute motor symptoms mimicking GBS, reviewing the relevant literature on misdiagnosis of GBS.
Collapse
Affiliation(s)
- G Sciacca
- Department "G. F. Ingrassia", Section of Neurosciences, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
| | - A Nicoletti
- Department "G. F. Ingrassia", Section of Neurosciences, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
| | - S Lo Fermo
- Department "G. F. Ingrassia", Section of Neurosciences, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
| | - G Mostile
- Department "G. F. Ingrassia", Section of Neurosciences, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
| | - C Giliberto
- Department "G. F. Ingrassia", Section of Neurosciences, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
| | - Mario Zappia
- Department "G. F. Ingrassia", Section of Neurosciences, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy.
| |
Collapse
|
2
|
Shenoy N, Tesfaye M, Brown J, Simmons N, Weiss D, Meholli M, Mabie P. Corticosteroid-resistant bulbar neurosarcoidosis responsive to intravenous immunoglobulin. Pract Neurol 2015; 15:289-92. [DOI: 10.1136/practneurol-2015-001112] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2015] [Indexed: 12/13/2022]
|
3
|
Gözübatik-Çelik G, Uygunoğlu U, Uludüz D, Atahan E, Müsellim B, Saip S, Siva A. Diagnosis and Treatment in Neurosarcoidosis. Noro Psikiyatr Ars 2015; 52:102-106. [PMID: 28360686 DOI: 10.5152/npa.2015.7318] [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: 07/09/2013] [Accepted: 02/20/2014] [Indexed: 11/22/2022] Open
Abstract
Sarcoidosis is an inflammatory multisystem disorder, affecting many systems such as lung, lymph nodes, skin and eye involvement. Nervous system involvement is often seen in 5-15% of patients with systemic sarcoidosis in the first two years. Preceding to systemic involvement the initial symptom as neurological complaints has been rarely reported. Lacking of any specific, clinical and / or radiological findings for neurosarcoidosis in these cases, it could be difficult to make an accurate diagnosis and histopathological evaluation may be required. Due to rarity and complexity diagnosis of the neurosarcoidosis, in this study, clinical, radiological and / or histopathological features, treatment modalities of the 7 neurosarcoidosis patients to be presented with detailed investigations of different neurological symptoms were evaluated.
Collapse
Affiliation(s)
- Gökçen Gözübatik-Çelik
- Department of Neurology, İstanbul University Cerrahpaşa Faculty of Medicine, İstanbul, Turkey
| | - Uğur Uygunoğlu
- Department of Neurology, İstanbul University Cerrahpaşa Faculty of Medicine, İstanbul, Turkey
| | - Derya Uludüz
- Department of Neurology, İstanbul University Cerrahpaşa Faculty of Medicine, İstanbul, Turkey
| | - Ersan Atahan
- Department of Pulmonology, İstanbul University Cerrahpaşa Faculty of Medicine, İstanbul, Turkey
| | - Benan Müsellim
- Department of Pulmonology, İstanbul University Cerrahpaşa Faculty of Medicine, İstanbul, Turkey
| | - Sabahattin Saip
- Department of Neurology, İstanbul University Cerrahpaşa Faculty of Medicine, İstanbul, Turkey
| | - Aksel Siva
- Department of Neurology, İstanbul University Cerrahpaşa Faculty of Medicine, İstanbul, Turkey
| |
Collapse
|
4
|
Reda HM, Taylor SW, Klein CJ, Boes CJ. A case of sensory ataxia as the presenting manifestation of neurosarcoidosis. Muscle Nerve 2011; 43:900-5. [PMID: 21607973 DOI: 10.1002/mus.22045] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Sarcoidosis rarely selectively affects the cauda equina with characteristic motor and sensory impairments.Using imaging, we report a case of cauda equina polyradiculopathy presenting with progressive sensory ataxia without clinical or electrophysiological evidence of motor involvement. Neurosarcoidosis was diagnosed pathologically by proximal dorsal root biopsy after systemic investigations for inflammatory, infectious, and neoplastic etiologies were found to be negative. There was clinical and radiographic improvement with corticosteroids. In addition, we review previously reported cases of cauda equina sarcoidosis.
Collapse
Affiliation(s)
- Haatem M Reda
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA.
| | | | | | | |
Collapse
|
5
|
Sarcoidosis presenting as "corset-like" myelopathy: a description of six cases and literature review. Clin Rev Allergy Immunol 2010; 38:270-5. [PMID: 19603148 DOI: 10.1007/s12016-009-8156-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Sarcoidosis of the spinal cord is rare, even more so as the initial presentation of the disease. We describe six cases of spinal cord sarcoidosis and delineate a distinguishing feature which may allow for a timely diagnosis. All patients were admitted with complaints of a "corset-like" pressure in the lower chest and later developed cranial nerve palsies (two patients), parasthesias/paraparesis (two patients), fever of unknown origin (one patient), and bilateral proptosis (one patient). Serological tests, immunological screening, cerebrospinal fluid (CSF) analysis, bacteriological and viral testing were performed in all patients. Spinal and cerebral MRI, high-resolution computed tomography (HRCT) of the chest and gallium scan suggested the diagnosis of neurosarcoidosis of the spine while a biopsy of mediastinal lymph nodes, extra-ocular muscles, or spinal cord confirmed it. CSF showed inflammatory signs in 66% of patients and serum ACE levels were increased in a similar fraction. MRI revealed a gadolinium-enhanced thickening of the cord at the thoracic level in three patients whereas three other patients had normal spinal MRI despite similar symptoms. The presence of mediastinal lymphadenopathy on HRCT of the chest suggested the diagnosis in a third of patients. Patients were treated with steroid, immunosuppressive therapy and/or biologic therapies, with complete resolution in one case, improvement in four, and a somewhat deteriorating course, with development of spinal cord atrophy in the final case. As spinal cord involvement of sarcoidosis is extremely rare, making the diagnosis in the absence of systemic disease is challenging. The cases herein described suggest that sensory disturbance in a "corset-like" distribution may be indicative of neurosarcoidosis, especially when accompanied by extra-axial involvement such as cranial nerve palsies. This should prompt an evaluation for systemic involvement, keeping in mind that serum ACE and chest radiographs may be normal in the presence of primarily CNS-limited disease.
Collapse
|
6
|
Neurosarcoidosis presenting as Guillain-Barré-like syndrome. A case report and review of the literature. J Clin Neuromuscul Dis 2009; 11:35-43. [PMID: 19730020 DOI: 10.1097/cnd.0b013e3181ae3be9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Sarcoidosis is a multisystem inflammatory disease that can affect the nervous system. Cranial neuropathies are the most frequent presentation of neurosarcoidosis. Involvement of the peripheral nervous system is less common. The presentation is usually subacute or chronic sensorimotor axonal polyneuropathy, whereas acute polyradiculopathy is extremely rare. We report a case of Guillain-Barré-like syndrome probably secondary to sarcoidosis. A review of the literature revealed 9 similar cases. The possibility of a Guillain-Barré-like syndrome as a presenting symptom of sarcoidosis should be considered, especially in patients with atypical features such as cerebrospinal fluid pleocytosis.
Collapse
|
7
|
Abstract
Although neurosarcoidosis seems to occur in only 5% to 10% of patients who have sarcoidosis, it may lead to significant complications. The diagnosis of neurosarcoidosis usually relies on indirect information from imaging and spinal fluid examination. Although MR imaging remains the most sensitive technique for detecting neurologic disease, other tests, including positron emission tomography scanning and cerebral spinal fluid examination, can provide important information. The role of immunosuppressive agents such as methotrexate, cyclophosphamide, and azathioprine has been expanded, and these agents should be considered for the treatment of some manifestations of neurosarcoidosis. Reports of the antitumor necrosis factor agent infliximab suggest that this drug can be helpful for patients who have neurosarcoidosis.
Collapse
Affiliation(s)
- Elyse E Lower
- Interstitial Lung Disease and Sarcoidosis Center, University of Cincinnati Medical Center, 3235 Eden Avenue, Cincinnati, OH 45267, USA.
| | | |
Collapse
|
8
|
Abstract
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.
Collapse
|
9
|
Hobson-Webb LD, Donofrio PD. Inflammatory neuropathies: an update on evaluation and treatment. Curr Rheumatol Rep 2005; 7:348-55. [PMID: 16174482 DOI: 10.1007/s11926-005-0019-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Inflammatory neuropathies are a diverse group of illnesses sharing the pathologic characteristic of inflammation surrounding nerve fibers. They may be autoimmune, granulomatous, infectious, paraneoplastic, or paraproteinemic in origin. All can result in significant morbidity and rarely, death. It is critical to correctly diagnose these illnesses, as many respond well to treatment. In this paper, the diagnosis and latest developments in the treatment of the most common inflammatory neuropathies (Guillain-Barré syndrome, chronic inflammatory demyelinating polyradiculoneuropathy, neurosarcoidosis, anti-myelin-associated glycoprotein neuropathy, Sjögren's syndrome, paraneoplastic neuronopathy, and vasculitic neuropathies) will be discussed.
Collapse
Affiliation(s)
- Lisa D Hobson-Webb
- Department of Neurology, Wake Forest University Health Sciences, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
| | | |
Collapse
|
10
|
Abstract
Sarcoidosis is an inflammatory multisystem disorder of unknown cause. Practically no organ is immune to sarcoidosis; most commonly, in up to 90% of patients, it affects the lungs. The nervous system is involved in 5-15% of patients. Neurosarcoidosis is a serious and commonly devastating complication of sarcoidosis. Clinical diagnosis of neurosarcoidosis depends on the finding of neurological disease in multisystem sarcoidosis. As the disease can present in many different ways without biopsy evidence, solitary nervous-system sarcoidosis is difficult to diagnose. Corticosteroids are the drug of first choice. In addition, several cytotoxic drugs, including methotrexate, have been used to treat sarcoidosis. The value of new drugs such as anti-tumour necrosis factor alpha will be assessed. In this review we describe the clinical manifestations of neurosarcoidosis, diagnostic dilemmas and considerations, and therapy.
Collapse
Affiliation(s)
- Elske Hoitsma
- Department of Neurology, Sarcoidosis Management Center, University Hospital Maastricht, Netherlands.
| | | | | | | |
Collapse
|
11
|
Abstract
PURPOSE OF REVIEW The neurological manifestations of sarcoidosis, which occur in 5% of patients with the condition, present in a variety of ways that can be assigned to several broad categories. A comprehensive approach to the diagnosis and management of neurosarcoidosis involves an appreciation of the strategies to confirm a diagnosis of sarcoidosis and neurosarcoidosis and the available therapeutic options. RECENT FINDINGS In addition to traditional approaches to the diagnosis of sarcoidosis, positron emission tomography can be used to identify otherwise occult sites of systemic inflammation which can be targeted for biopsy. Although corticosteroids remain the mainstay of treatment, other immunosuppressive and immunomodulatory agents can be used in the multi-modality therapy of sarcoidosis. SUMMARY Neurosarcoidosis can be 'staged' with the use of neurodiagnostic testing and diagnosed with varying degrees of certainty. Treatment should be approached within the context of the anticipated clinical course of the patient, avoidance of adverse drug effects, and, as necessary, from the perspective of the comprehensive management of a chronic disease.
Collapse
Affiliation(s)
- Barney J Stern
- Department of Neurology, Emory University, Atlanta, Georgia, USA.
| |
Collapse
|