1
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Distinguishing CNS neurosarcoidosis from multiple sclerosis and an approach to “overlap” cases. J Neuroimmunol 2022; 369:577904. [DOI: 10.1016/j.jneuroim.2022.577904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 05/30/2022] [Accepted: 05/30/2022] [Indexed: 12/17/2022]
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2
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Yates WB, McCluskey PJ, Fraser CL. Neuro-ophthalmological manifestations of sarcoidosis. J Neuroimmunol 2022; 367:577851. [DOI: 10.1016/j.jneuroim.2022.577851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 03/22/2022] [Accepted: 03/23/2022] [Indexed: 11/17/2022]
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3
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Kumar A, Mishra SK, Jhanwar M, Muthu Kamal VKB, Gaur S, Karan S. Optic disc granuloma with retinal vein occlusion: rare presentation of neuro-ophthalmic sarcoidosis. QJM 2021; 114:200-201. [PMID: 32458978 DOI: 10.1093/qjmed/hcaa180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A Kumar
- Department of Ophthalmology, Army College of Medical Sciences & Base Hospital Delhi Cantt, 110010, India
| | - S K Mishra
- Department of Ophthalmology, Army College of Medical Sciences & Base Hospital Delhi Cantt, 110010, India
| | - M Jhanwar
- Department of Ophthalmology, Army College of Medical Sciences & Base Hospital Delhi Cantt, 110010, India
| | - V K B Muthu Kamal
- Department of Ophthalmology, Army College of Medical Sciences & Base Hospital Delhi Cantt, 110010, India
| | - S Gaur
- Department of Ophthalmology, Army College of Medical Sciences & Base Hospital Delhi Cantt, 110010, India
| | - S Karan
- Department of Ophthalmology, Army College of Medical Sciences & Base Hospital Delhi Cantt, 110010, India
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Laura D, Lee Y, Farhangi M, Salamo O, Mirsaeidi M, Goldhardt R, Galor A. Ocular Manifestations of Sarcoidosis in a South Florida Population. Clin Ophthalmol 2020; 14:3741-3746. [PMID: 33173272 PMCID: PMC7648141 DOI: 10.2147/opth.s278373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 10/09/2020] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To describe the ocular manifestations of sarcoidosis in a South Florida population and identify risk factors for the presence of ocular disease. DESIGN Retrospective consecutive case series. METHODS Medical charts of individuals with sarcoidosis seen in the University of Miami pulmonary department were reviewed for ocular disease. Odds ratios were used to identify risk factors for ocular sarcoidosis. RESULTS Fourteen of 108 individuals with sarcoidosis had ocular involvement. The mean age of the 14 individuals was 56±15 years. Seventy-one percent were female, 50% were black, and 21% were Hispanic. Twelve had uveitis of which panuveitis was the most common subtype. Five had ≤20/70 vision in at least one eye due to uveitis. Neurosarcoidosis was a risk factor for ocular sarcoidosis (OR 6.14, p=0.03, 95% CI 1.21-31.09). CONCLUSION Ocular manifestations occurred in a minority of individuals in a pulmonary sarcoidosis clinic in South Florida. Uveitis was the most common ocular manifestation. Neurosarcoidosis was a risk factor for ocular involvement.
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Affiliation(s)
- Diana Laura
- Miami Veterans Administration Medical Center, Miami, FL33125, USA
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miami, FL33136, USA
| | - Yonghoon Lee
- Miami Veterans Administration Medical Center, Miami, FL33125, USA
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miami, FL33136, USA
| | - Monika Farhangi
- Miami Veterans Administration Medical Center, Miami, FL33125, USA
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miami, FL33136, USA
| | - Oriana Salamo
- Miami Veterans Administration Medical Center, Miami, FL33125, USA
| | - Mehdi Mirsaeidi
- Miami Veterans Administration Medical Center, Miami, FL33125, USA
- Department of Pulmonology, University of Miami, Miami, FL33125, USA
| | - Raquel Goldhardt
- Miami Veterans Administration Medical Center, Miami, FL33125, USA
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miami, FL33136, USA
| | - Anat Galor
- Miami Veterans Administration Medical Center, Miami, FL33125, USA
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miami, FL33136, USA
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Sève P, Jamilloux Y, Tilikete C, Gerfaud-Valentin M, Kodjikian L, El Jammal T. Ocular Sarcoidosis. Semin Respir Crit Care Med 2020; 41:673-688. [PMID: 32777852 DOI: 10.1055/s-0040-1710536] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Sarcoidosis is one of the leading causes of inflammatory eye disease. Any part of the eye and its adnexal tissues can be involved. Uveitis and optic neuropathy are the main manifestations, which may require systemic treatment. Two groups of patients with sarcoid uveitis can be distinguished: one of either sex and any ethnicity in which ophthalmological findings are various and another group of elderly Caucasian women with mostly chronic posterior uveitis. Clinically isolated uveitis revealing sarcoidosis remains a strictly ocular condition in a large majority of cases. Although it can be a serious condition involving functional prognosis, early recognition in addition to a growing therapeutic arsenal (including intravitreal implant) has improved the visual prognosis of the disease in recent years. Systemic corticosteroids are indicated when uveitis does not respond to topical corticosteroids or when there is bilateral posterior involvement, especially macular edema. In up to 30% of the cases that require an unacceptable dosage of corticosteroids to maintain remission, additional immunosuppression is used, especially methotrexate. As with other forms of severe noninfectious uveitis, monoclonal antibodies against tumor necrosis factor-α have been used. However, only very rarely does sarcoid uveitis fail to respond to combined corticosteroids and methotrexate therapy, a situation that should suggest either poor adherence or another granulomatous disease. Optic neuropathy often affects women of African and Caribbean origins. Some authors recommend that patients should be treated with high-dose of corticosteroids and concurrent immunosuppression from the onset of this manifestation, which is associated with a poorer outcome.
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Affiliation(s)
- Pascal Sève
- Department of Internal Medicine, Hopital de la Croix-Rousse, Université Claude Bernard Lyon I, Lyon, France.,Hospices Civils de Lyon, Pôle IMER, Lyon, France.,University Claude Bernard-Lyon 1, HESPER EA 7425, Univ. Lyon, Lyon, France
| | - Yvan Jamilloux
- Department of Internal Medicine, Hopital de la Croix-Rousse, Université Claude Bernard Lyon I, Lyon, France
| | - Caroline Tilikete
- Department of Internal Medicine, Hopital de la Croix-Rousse, Université Claude Bernard Lyon I, Lyon, France
| | - Mathieu Gerfaud-Valentin
- Department of Internal Medicine, Hopital de la Croix-Rousse, Université Claude Bernard Lyon I, Lyon, France
| | - Laurent Kodjikian
- Neurology D and Neuro-Ophthalmology Unit, Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Bron, France.,Université de Lyon, Lyon 1 University, Lyon, France.,Lyon Neuroscience Research Center, INSERM U1028 CNRS UMR5292, Team ImpAct, Bron, France.,Department of Ophthalmology, Hopital de la Croix-Rousse, Université Claude Bernard Lyon I, Lyon, France
| | - Thomas El Jammal
- Department of Internal Medicine, Hopital de la Croix-Rousse, Université Claude Bernard Lyon I, Lyon, France
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Tanyıldız B, Doğan G, Zorlutuna Kaymak N, Tezcan ME, Kılıç AK, Şener Cömert S, Karatay Arsan A. Optic Neuropathy and Macular Ischemia Associated with Neurosarcoidosis: A Case Report. Turk J Ophthalmol 2018; 48:202-205. [PMID: 30202617 PMCID: PMC6126102 DOI: 10.4274/tjo.49799] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 02/18/2018] [Indexed: 12/01/2022] Open
Abstract
In this study, we present a case of bilateral optic neuropathy and macular ischemia in the right eye associated with neurosarcoidosis. A 26-year-old woman presented to our clinic with complaints of bilateral blurred vision. Bilateral granulomatous anterior uveitis, vitritis, optic neuropathy, and macular ischemia were detected in the right eye in slit-lamp examination. She also reported complaints of fever, weakness, sweating, arthralgia, and headache for 2 months. She was referred to the pulmonary diseases unit of our hospital due to hilar lymphadenopathy seen in her chest x-ray, and biopsies were taken for diagnostic purposes. Histological analysis of the mediastinal lymph node biopsies revealed chronic, non-caseating, granulomatous inflammation. Furthermore, the patient was referred to a neurologist due to concomitant complaint of intense headaches. She was diagnosed with neurosarcoidosis supported by findings on cranial magnetic resonance imaging and lumbar puncture. She received a 3-day course of high-dose (1 g/day) intravenous steroid treatment (methylprednisolone) followed by a tapering dose of oral prednisone. The patient began receiving oral methotrexate 15 mg/week as a steroid-sparing agent. Significant improvement in neurological and ophthalmological symptoms occurred in the first week of treatment. In this case report, we emphasized that neurosarcoidosis should be included in the differential diagnosis of patients with both bilateral optic neuropathy and macular ischemia. Furthermore, early diagnosis and timely treatment of neurosarcoidosis are important for favorable visual outcomes.
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Affiliation(s)
- Burak Tanyıldız
- University of Health Sciences, Kartal Dr. Lütfi Kırdar Training and Research Hospital, Ophthalmology Clinic, İstanbul, Turkey
| | - Gizem Doğan
- University of Health Sciences, Kartal Dr. Lütfi Kırdar Training and Research Hospital, Ophthalmology Clinic, İstanbul, Turkey
| | - Nilüfer Zorlutuna Kaymak
- University of Health Sciences, Kartal Dr. Lütfi Kırdar Training and Research Hospital, Ophthalmology Clinic, İstanbul, Turkey
| | - Mehmet Engin Tezcan
- University of Health Sciences, Kartal Dr. Lütfi Kırdar Training and Research Hospital, Rheumatology Clinic, İstanbul, Turkey
| | - Ahmet Kasım Kılıç
- University of Health Sciences, Kartal Dr. Lütfi Kırdar Training and Research Hospital, Neuorology Clinic, İstanbul, Turkey
| | - Sevda Şener Cömert
- University of Health Sciences, Kartal Dr. Lütfi Kırdar Training and Research Hospital, Pulmonary Diseases Clinic, İstanbul, Turkey
| | - Aysu Karatay Arsan
- University of Health Sciences, Kartal Dr. Lütfi Kırdar Training and Research Hospital, Ophthalmology Clinic, İstanbul, Turkey
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Vereecken M, Hollanders K, De Bruyn D, Ninclaus V, De Zaeytijd J, De Schryver I. An atypical case of neurosarcoidosis presenting with neovascular glaucoma. J Ophthalmic Inflamm Infect 2018; 8:7. [PMID: 29671151 PMCID: PMC5906415 DOI: 10.1186/s12348-018-0149-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Accepted: 03/19/2018] [Indexed: 01/27/2023] Open
Abstract
Background Sarcoidosis, a multisystem, granulomatous disorder, sometimes manifests with a neuro-ophthalmic subtype. The latter can pose a diagnostic challenge, especially when ocular symptoms appear before systemic involvement, as the clinical picture then can be non-specific and systemic laboratory and standard imaging investigations can be negative. Findings A 71-year-old woman presented with a 4-month history of sudden-onset visual loss in the left eye. Slit lamp examination revealed anterior chamber cells, iris, and angle neovascularization. Fundoscopy showed a pale edematous optic nerve head surrounded with intraretinal hemorrhages and yellow retinal infiltrates. The vasculature was very narrow to absent. Indeed, fluorescein angiography filling was limited to the (juxta-)papillary region. An extensive systemic work-up revealed a monoclonal gammopathy and absence of any inflammatory markers. On MRI, a mass infiltration of the intraorbital and the intracranial optic nerve was visible. Additional PET-CT scan revealed hilar lymph nodes. A transbronchial biopsy demonstrating a non-caseating granulomatous lesion led to the diagnosis of sarcoidosis and thus neurosarcoidosis. Treatment with high-dose prednisone and azathioprine was started to avoid progression and subsequent visual loss in the other eye. Conclusions A patient with neurosarcoidosis presenting with compressive ischemic optic disc edema and neovascular glaucoma is described, increasing the diversity of clinical presentations and confirming the diagnostic challenge of neurosarcoidosis.
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Affiliation(s)
- Melissa Vereecken
- Department of Ophthalmology, University Hospital Ghent, De Pintelaan 185, 9000, Ghent, Belgium.
| | - Karolien Hollanders
- Department of Ophthalmology, University Hospital Ghent, De Pintelaan 185, 9000, Ghent, Belgium
| | - Deborah De Bruyn
- Department of Ophthalmology, University Hospital Ghent, De Pintelaan 185, 9000, Ghent, Belgium
| | - Virginie Ninclaus
- Department of Ophthalmology, University Hospital Ghent, De Pintelaan 185, 9000, Ghent, Belgium
| | - Julie De Zaeytijd
- Department of Ophthalmology, University Hospital Ghent, De Pintelaan 185, 9000, Ghent, Belgium
| | - Ilse De Schryver
- Department of Ophthalmology, University Hospital Ghent, De Pintelaan 185, 9000, Ghent, Belgium
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Ganesh SK, Kaduskar AV. Optic nerve head granuloma as a primary manifestation of ocular sarcoidosis - A tertiary uveitis clinic experience. Oman J Ophthalmol 2016; 8:157-61. [PMID: 26903720 PMCID: PMC4738659 DOI: 10.4103/0974-620x.169890] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose: To report a case series of ocular sarcoidosis manifesting as optic nerve head granuloma. Design: Observational case series. Results: Unilateral presentation in three females and a male. None of them had symptoms suggestive of systemic involvement. Fundus examination in all the patients showed hyperemic optic discs with peripapillary subretinal granuloma. Serum angiotensin converting enzyme was elevated in all patients. Chest radiograph was within normal limits in all patients. High resolution computed tomography of the chest showed features of sarcoidosis in two patients. All patients were treated with oral steroids. Immunosupressants were given in three patients, intravenous steroid, followed by oral steroids given in three patients. Improvement in visual acuity was noted in all four patients. Conclusion: Primary optic nerve involvement in sarcoidosis is rare. Isolated optic nerve sarcoidosis may exist without any systemic manifestations. Corticosteroids with immunosuppressants form the mainstay of therapy.
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Affiliation(s)
- Sudha K Ganesh
- Department of Uveitis, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Anushree Vijay Kaduskar
- Department of Uveitis, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
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Anthony J, Esper GJ, Ioachimescu A. Hypothalamic-pituitary sarcoidosis with vision loss and hypopituitarism: case series and literature review. Pituitary 2016; 19:19-29. [PMID: 26267304 DOI: 10.1007/s11102-015-0678-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
PURPOSE Hypothalamic-pituitary (HP) neurosarcoidosis (NS) accounts for 0.5 % cases of sarcoidosis and 1 % of HP masses. Correlative data on endocrine and neurological outcomes is lacking. METHODS Retrospective case series and literature review of presentation, treatment and outcome of HP NS. RESULTS Our series includes 4 men, ages 34-59, followed for a median of 7.3 years (range 1.5-17). All had optic neuropathy, multiple pituitary hormone abnormalities (PHAs) and other organ involvement by sarcoidosis (lung, sino-nasal, brain/spine and facial nerve). Two patients had central diabetes insipidus and one impaired thirst with polydipsia. After treatment with high-dose glucocorticoids, optic neuropathy improved in one case and stabilized in the others. After treatment, HP lesions improved radiologically, but PHAs persisted in all cases. Review of four published series on HP NS in addition to ours yielded 46 patients, age 37 ± 11.8 years, 65 % male. PHAs consisted of anterior hypopituitarism (LH/FSH 88.8 %, TSH 67.4 %, GH 50.0 %, ACTH 48.8 %), hyperprolactinemia (48.8 %) and diabetes insipidus (65.2 %). PHAs were the first sign of disease in 54.3 % patients. Vision problems occurred in 28.3 % patients, but optic neuropathy was not well documented in previous series. Most patients (93.5 %) received high-dose glucocorticoids followed by taper; 50 % also received other immunomodulators, including methotrexate, mycophenolate mofetil, cyclosporine, azathioprine, infliximab and hydrochloroquine. Only 13 % patients showed improvement in PHAs. All-cause mortality was 8.7 %. CONCLUSION HP NS is a serious disease requiring multidisciplinary treatment and lifelong follow-up. Prospective multicentric studies are needed to determine a more standardized approach to HP NS and outline predictors of disease outcome.
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Affiliation(s)
- Jeremy Anthony
- Specialty Care, Atlanta Veterans Affairs Medical Center, Decatur, GA, USA
- Division of Endocrinology, Department of Medicine, Emory University, 1365 B Clifton Rd., NE, B6209, Atlanta, GA, 30322, USA
| | | | - Adriana Ioachimescu
- Division of Endocrinology, Department of Medicine, Emory University, 1365 B Clifton Rd., NE, B6209, Atlanta, GA, 30322, USA.
- Department of Neurosurgery, Emory University, Atlanta, GA, USA.
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10
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[Management of uveomeningitis in internal medicine: Proposal for a diagnostic work-up]. Rev Med Interne 2015; 37:25-34. [PMID: 26541836 DOI: 10.1016/j.revmed.2015.09.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 07/03/2015] [Accepted: 09/26/2015] [Indexed: 01/14/2023]
Abstract
Uveomeningitis relates to an inflammatory state extending from iris and ciliary bodies to the choroid behind the eye. Because of a close contact between eye and brain, and barrier disruption, the inflammation can spread into the central nervous system (CNS). We review the clinical manifestations of uveitis, which are known to provide helpful clues to the diagnosis and describe the infectious, inflammatory, and neoplastic conditions classically associated with the uveomeningitis. Inflammatory or auto-immune diseases are probably the most common clinically recognized causes of uveomeningitis associated with a significant pleiocytosis. These entities often cause inflammation of various tissues in the body, including ocular structures and the meninges (i.e., sarcoidosis, Behçet's disease, and Vogt-Koyanagi-Harada syndrome). The association of an infectious uveitis with an acute or a chronic meningo-encephalitis is unusual but occasionally the eye examination may suggest an infectious etiology or even a specific organism responsible for an uveomeningitis. One should consider the diagnosis of primary ocular-CNS lymphoma in patients of 40 years of age or older with bilateral uveitis, especially with prominent vitritis, showing poor response to corticosteroid therapy. Finally, an algorithm for the diagnostic approach of uveomeningitis is proposed.
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11
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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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13
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Nozaki K, Judson MA. Neurosarcoidosis: Clinical manifestations, diagnosis and treatment. Presse Med 2012; 41:e331-48. [PMID: 22595777 DOI: 10.1016/j.lpm.2011.12.017] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2011] [Revised: 12/06/2011] [Accepted: 12/09/2011] [Indexed: 10/28/2022] Open
Abstract
Sarcoidosis is an idiopathic granulomatous disease affecting multiple organs. Neurosarcoidosis, involving the central and/or peripheral nervous systems, is a relatively rare form of sarcoidosis. Its clinical manifestations include cranial neuropathies, meningitis, neuroendocrinological dysfunction, hydrocephalus, seizures, neuropsychiatric symptoms, myelopathy and neuropathies. The diagnosis is problematic, especially when occurring as an isolated form without other organ involvement. Distinguishing neurosarcoidosis from other granulomatous diseases and multiple sclerosis is especially important. Although biopsy of neural tissue is the gold standard for the diagnosis of neurosarcoidosis, this is often not practical and the diagnosis must be inferred though other tests, often coupled with biopsy of extraneural organs. Corticosteroids and other immuno-suppressants are frequently used for the treatment of neurosarcoidosis. This article reviews the epidemiology, pathogenesis, pathology, clinical features, diagnosis, diagnostic tests, diagnostic criteria, and therapy of neurosarcoidosis.
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Affiliation(s)
- Kenkichi Nozaki
- Medical University of South Carolina, Department of Neurosciences, Division of Neurology, Charleston, South Carolina 29425, United States of America.
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Isolated sixth cranial nerve palsy as the presenting symptom of a rapidly expanding ACTH positive pituitary adenoma: a case report. BMC Ophthalmol 2011; 11:4. [PMID: 21272327 PMCID: PMC3041999 DOI: 10.1186/1471-2415-11-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2010] [Accepted: 01/27/2011] [Indexed: 11/21/2022] Open
Abstract
Background Pituitary adenoma may present with neuro-ophthalmic manifestations and, typically, rapid tumor expansion is the result of apoplexy. Herein, we present the first case of an isolated sixth cranial nerve palsy as initial feature of a rapidly expanding ACTH positive silent tumor without apoplexy. Case Presentation A 44 year old female with a history of sarcoidosis presented with an isolated sixth cranial nerve palsy as the initial clinical feature of a rapidly expanding ACTH positive silent pituitary adenoma. The patient underwent emergent transsphenoidal hypophysectomy for this rapidly progressive tumor and subsequently regained complete vision and ocular motility. Despite tumor extension into the cavernous sinus, the other cranial nerves were spared during the initial presentation. Conclusions This case illustrates the need to consider a rapidly growing pituitary tumor as a possibility when presented with a rapidly progressive ophthalmoplegia.
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15
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Current world literature. Curr Opin Ophthalmol 2010; 21:495-501. [PMID: 20948381 DOI: 10.1097/icu.0b013e3283402a34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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