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Fain O, Mekinian A. Les pachyméningites. Rev Med Interne 2017; 38:585-591. [DOI: 10.1016/j.revmed.2017.03.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 03/10/2017] [Indexed: 01/29/2023]
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Krenzlin H, Jussen D, Musahl C, Scheil-Bertram S, Wernecke K, Horn P. A Rare Case of Isolated Cerebral Sarcoidosis Presenting as Suprasellar Mass Lesion with Salt-Wasting Hypopituitarism. J Neurol Surg Rep 2015; 76:e140-5. [PMID: 26251792 PMCID: PMC4520996 DOI: 10.1055/s-0035-1549310] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Accepted: 02/14/2015] [Indexed: 11/09/2022] Open
Abstract
Background Sarcoidosis is a systemic disorder of unknown origin characterized by noncaseating granulomas. Clinical symptoms due to central nervous system (CNS) involvement occur in 5 to 7% of all cases; subclinical involvement is more frequent. Sole CNS involvement is very rare. Case Report A 25-year-old man presented with increasing polyuria and polydipsia over 8 weeks. Magnetic resonance imaging (MRI) revealed a supra- and infra-chiasmatic pre-thalamic mass lesion 1.0 × 1.4 × 1.4cm in diameter. Microsurgical biopsy verified a necrotizing noncaseating epithelioid cell tumor indicative for neurosarcoidosis. All symptoms dissolved within 3 months under stringent corticoid therapy. Conclusion Intracranial mass lesions as the primary and only manifestation of neuronal sarcoidosis are rare. Because conservative treatment is safe and effective, surgery is limited to biopsy and the alleviation of pressure-related symptoms to preserve neurologic function.
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Affiliation(s)
- H Krenzlin
- Department of Neurosurgery, Dr. Horst Schmidt Kliniken, HELIOS Klinikum, Wiesbaden, Germany
| | - D Jussen
- Department of Neurosurgery, Dr. Horst Schmidt Kliniken, HELIOS Klinikum, Wiesbaden, Germany
| | - C Musahl
- Department of Neurosurgery, Dr. Horst Schmidt Kliniken, HELIOS Klinikum, Wiesbaden, Germany
| | - S Scheil-Bertram
- Department of Pathology and Cytology, Dr. Horst Schmidt Kliniken, HELIOS Klinikum, Wiesbaden, Germany
| | - K Wernecke
- Department of Radiology and Radiotherapy (RNS), Dr. Horst Schmidt Kliniken, Wiesbaden, Germany
| | - P Horn
- Department of Neurosurgery, Dr. Horst Schmidt Kliniken, HELIOS Klinikum, Wiesbaden, Germany
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Mijajlovic M, Mirkovic M, Mihailovic-Vucinic V, Aleksic V, Covickovic-Sternic N. Neurosarcoidosis: two case reports with multiple cranial nerve involvement and review of the literature. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2013; 158:662-7. [PMID: 23817300 DOI: 10.5507/bp.2013.047] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2012] [Accepted: 06/06/2013] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Involvement of the central nervous system is registered in a relatively small number of patients with sarcoidosis. In this article we present two cases with various neurological symptoms that fulfill criteria for neurosarcoidosis (NS). In addition, we review the literature on NS with special attention to isolated cranial nerve involvement. METHODS AND RESULTS First patient: Neurological examination identified multiple cranial neuropathy, moderate right-sided hemiparesis, polyradiculoneuritis of the lower limbs and positive meningeal signs. Laboratory tests showed serum and cerebrospinal fluid (CSF) inflammatory abnormalities, with increased values of the angiotensin-converting enzyme (ACE). CSF analysis also showed presence of 9 oligoclonal IgG bands. Brain and spine magnetic resonance imaging (MRI) revealed diffuse meningopathy, and focal granulomatous lesion in the body of the L5 vertebra. Lung sarcoidosis was confirmed by additional diagnostic procedures. The patient was treated with Methylprednisolone and a tapering course of oral Prednisone, which reduced the pain in the back and legs and improved the strength of the right leg. However, the other neurological deficiencies remained. After confirming lung sarcoidosis, the patient received Methotrexate in addition to Prednisone but during the following 2 years the patient's condition progressively worsened and ended in death. Second patient: Neurological findings showed weakness of the right n. oculomotorius and the right n. trochlearis, as well as the right-side face weakness. We found raised level of the ACE in serum and CSF. Thorax high-definition computed tomography (HDCTT) showed ribbon-like domains of discrete changes in the pulmonary parenchyma. MRI of the brain showed multiple white matter lesions. This patient also received Methylprednisolone followed by Prednisone, and after two months, ocular motility normalized. CONCLUSION The diagnosis of NS is always a challenge. For this rerason definitive diagnosis requires the exclusion of other causes of neuropathy. Multiple cranial neuropathies should always arouse suspicion of NS.
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Affiliation(s)
- Milija Mijajlovic
- Neurology Clinic, Clinical Center of Serbia and School of Medicine, University of Belgrade, Serbia
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Abstract
Sarcoidosis is a multisystem granulomatous disorder that most commonly presents with pulmonary involvement. The diagnosis is suggested on the basis of clinical and radiologic manifestations and is supported by the histological demonstration of noncaseating granulomas in affected tissues. Different imaging modalities, including chest radiography, X-rays, computed tomography, magnetic resonance imaging, and (67) Ga scintigraphy are currently employed to help diagnose and help plan treatment strategy in sarcoidosis patients. Here, we discuss the potential role of positron emission tomography in the diagnosis, assessment of disease activity, and management of patients with sarcoidosis. We also point out some of the limitations of this technique.
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Affiliation(s)
- Vivek Jain
- GW Medical Faculty Associates, Division of Pulmonary, Critical Care, and Sleep Medicine, George Washington University Hospital, Washington, DC, USA.
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6
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The challenge of profound hypoglycorrhachia: two cases of sarcoidosis and review of the literature. Clin Rheumatol 2011; 30:1631-9. [PMID: 21870035 DOI: 10.1007/s10067-011-1834-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2011] [Accepted: 08/15/2011] [Indexed: 10/17/2022]
Abstract
We report two cases of sarcoidosis which were initially misdiagnosed due to profound hypoglycorrhachia. Sarcoidosis is a systemic inflammatory disorder which can mimick other entities and has a vast array of presentations including altered mentation and signs of increased intracranial pressure. Though hypoglycorrhachia has been described previously, these two cases are unique in not only the level of hypoglycorrhachia but also the diagnostic challenge presented. We propose that sarcoidosis should be in the differential of all cases of CNS diseases with any level of hypoglycorrhachia.
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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.
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Affiliation(s)
- Elyse E Lower
- Interstitial Lung Disease and Sarcoidosis Center, University of Cincinnati Medical Center, 3235 Eden Avenue, Cincinnati, OH 45267, USA.
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9
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Bihan H, Christozova V, Dumas JL, Jomaa R, Valeyre D, Tazi A, Reach G, Krivitzky A, Cohen R. Sarcoidosis: clinical, hormonal, and magnetic resonance imaging (MRI) manifestations of hypothalamic-pituitary disease in 9 patients and review of the literature. Medicine (Baltimore) 2007; 86:259-268. [PMID: 17873755 DOI: 10.1097/md.0b013e31815585aa] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Hypothalamic-pituitary (HP) sarcoidosis has 2 main endocrine manifestations: diabetes insipidus and hyperprolactinemia. We conducted the current study to investigate pituitary dysfunction and perform imaging of the HP area in patients both immediately following diagnosis and after treatment. The study included 6 men and 3 women, with a mean age of 30 years at the onset of sarcoidosis. All patients had both hormonal and magnetic resonance imaging (MRI) HP disorders. All patients had anterior pituitary dysfunction, 7 of them with associated diabetes insipidus. Nine patients had gonadotropin deficiency and 3 had hyperprolactinemia. MRI revealed infundibulum involvement in 5 patients, pituitary stalk thickness abnormality in 5, and involvement of the pituitary gland in 2, associated with other parenchymal brain or spinal cord lesions in 6 patients. All patients had multiple localizations of sarcoidosis, and 5 had histologically confirmed sinonasal localizations. Mean follow-up of the HP disorder was 7.5 years. All patients received prednisone. There was no correlation between the number of hormonal dysfunctions and the area of the HP axis involved as assessed by MRI. Although corticoid treatment was associated with a reduction of radiologic lesions, only 2 patients had partial recovery of hormonal deficiency. In conclusion, hormonal deficiencies associated with HP sarcoidosis frequently include hypogonadism (all patients) and to a lesser degree diabetes insipidus (7 of 9 patients). MRI abnormalities improved or disappeared in 7 cases under corticosteroid treatment, but most endocrine defects were irreversible despite regression of the granulomatous process. Most cases presented with multivisceral localizations and an abnormally high proportion of sinonasal localizations.
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Affiliation(s)
- Hélène Bihan
- From Department of Internal Medicine and Endocrinology (HB, VC, RJ, GR, AK, RC), Service of Radiology (J-LD), Department of Pneumology (DV), Avicenne Hospital, University of Paris, Bobigny; and Department of Pneumology (AT), Saint-Louis Hospital, AP-HP, Paris, France
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10
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Abstract
Neurosarcoidosis is an uncommon disorder and requires a careful clinical evaluation to reach a diagnosis. Generally, patients with peripheral symptoms, which include paresthesias, muscle weakness, and stocking glove deficits, have a better outcome compared with those with central nervous system involvement. Patients with mass lesions or hydrocephalus tend to have more relapses and are often more resistant to routine therapy. Neurosarcoidosis often responds to glucocorticoids, usually within days or weeks of initiating therapy. Patients are usually maintained on 40 to 80 mg per day for 4 to 6 weeks, which is then tapered slowly. Alternative treatments for refractory neurosarcoidosis, or to reduce or eliminate steroids, include methotrexate, cyclophosphamide, azathioprine, cyclosporine, infliximab, chlorambucil, chloroquine, and hydroxychloroquine.
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Affiliation(s)
- Ashok V Patel
- William R. Tyor, MD Neurology Service, Ralph H. Johnson VA Medical Center, 109 Bee Street, Charleston, SC 29401, USA.
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11
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Abstract
Chronic meningitis is a syndrome commonly defined by the presence of continuously persistent meningeal inflammation for at least 4 weeks. Presenting neurologic features are often nonspecific, and the list of differential diagnoses is broad. Despite the development of modern molecular diagnostic methods, establishing a specific cause may challenge the acumen of the treating neurologist with clues to the diagnosis residing outside the nervous system and requiring focused investigation. This review discusses selected etiologies illustrating issues in diagnosis and etiologic categories to be considered in the evaluation of this challenging syndrome.
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Affiliation(s)
- Bruce A Cohen
- Davee Department of Neurology, Feinberg School of Medicine, Northwestern University, 710 North Lake Shore Drive, Abbott Hall 1121, Chicago, IL 60611, USA.
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12
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Reske D, Petereit HF, Heiss WD. Difficulties in the differentiation of chronic inflammatory diseases of the central nervous system--value of cerebrospinal fluid analysis and immunological abnormalities in the diagnosis. Acta Neurol Scand 2005; 112:207-13. [PMID: 16146488 DOI: 10.1111/j.1600-0404.2005.00414.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES A number of neurological syndromes may be evoked by involvement of the nervous system due to systemic diseases such as lupus erythematodes, sarcoidosis, Behçet's disease and Sjögren's syndrome (SS) and may be confounded with another chronic inflammatory disease which is restricted to the central nervous system, e.g. multiple sclerosis (MS). Because of different treatment strategies, it is important to distinguish between these different autoimmune diseases. RESULTS Neither clinical signs nor additional analyses such as serological findings or cerebrospinal fluid (CSF) analysis are able to differentiate between the diseases with certainty. Nevertheless, taking all findings together, diagnosis may be possible. CONCLUSION Here we compare typical clinical and CSF findings in MS, neurosarcoidosis, neurolupus, neuro-Behçet and nervous system involving SS with special emphasis on those findings allowing differentiation of the respective diseases by reviewing the literature.
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Affiliation(s)
- D Reske
- Department of Neurology, University of Cologne, Cologne, Germany.
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Kanzaki S, Inoue Y, Watabe T, Ogawa K. Hypertrophic chronic pachymeningitis associated with chronic otitis media and mastoiditis. Auris Nasus Larynx 2005; 31:155-9. [PMID: 15121225 DOI: 10.1016/j.anl.2004.01.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2003] [Accepted: 01/16/2004] [Indexed: 11/20/2022]
Abstract
We describe the case history of a 70-year-old female patient presenting with bilateral hearing disturbance, facial paralysis, and vertigo. Radiological tests of temporal bone revealed soft tissue in the mastoid and tympanic cavities, and T1 weighted MRI revealed prominent Gd enhancement of the middle skull basal meninges. Middle ear inflammation appeared to induce pachymeningitis and to exacerbate associated symptoms, leading to a decline in the patient's overall condition. Bilateral mastoidectomies were effective in improving her general condition. Her hearing improved only on the right side because ossiculoplasty was performed only on that side. Her facial movement progressively improved and pachymeningitis diminished over time. We speculate that removal of the infectious granulation within the middle ears and mastoids ameliorated the acute inflammation. The etiology remains unknown in this case.
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Affiliation(s)
- Sho Kanzaki
- Department of Otolaryngology, Head and Neck Surgery, Keio University Hospital, 35 Shinanomachi, Shinjuku, Tokyo 160-0082, Japan.
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Reske D, Petereit HF. [Differential diagnosis of chronic inflammatory diseases of the central nervous system. Cerebrospinal fluid diagnosis and immunological parameters]. DER NERVENARZT 2004; 75:945-52. [PMID: 15060767 DOI: 10.1007/s00115-004-1699-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A number of neurological syndromes may be evoked by involvement of the nervous system due to systemic diseases such as lupus erythematosus, sarcoidosis, Behcet's disease, and Sjogren's syndrome. Because of different treatment strategies, it is important to distinguish between these different diseases. Neither clinical signs nor additional analyses such as serological findings or cerebrospinal fluid analysis are able to differentiate between the diseases with certainty. Nevertheless, diagnosis may finally be made taking all findings together. Here we compare typical clinical and cerebrospinal fluid findings in neurosarcoidosis, neurolupus, neuro-Behcet, and nervous system involving Sjogren's syndrome, with special emphasis on those findings allowing differentiation of the respective diseases.
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Affiliation(s)
- D Reske
- Klinik und Poliklinik für Neurologie, Klinikum der Universität zu Köln, Köln.
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15
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Abstract
Classical descriptions of the temporal bone are based on its five embryologically distinct osseous components: the petrous, tympanic, mastoid, squamous, and styloid portions.
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Affiliation(s)
- H Christian Davidson
- Department of Radiology, Veterans Affairs Salt Lake City Health Care System, University of Utah, 500 South Foothill Drive, Salt Lake City, UT 84148, USA
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16
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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.
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Affiliation(s)
- Elske Hoitsma
- Department of Neurology, Sarcoidosis Management Center, University Hospital Maastricht, Netherlands.
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17
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Mahadewa TGB, Nakagawa H, Watabe T, Inoue T. Intramedullary neurosarcoidosis in the medulla oblongata: a case report. ACTA ACUST UNITED AC 2004; 61:283-7; discussion 287. [PMID: 14985005 DOI: 10.1016/s0090-3019(03)00398-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2002] [Accepted: 03/10/2003] [Indexed: 11/18/2022]
Abstract
OBJECTIVE We present a rare case of neurosarcoidosis mimicking an intramedullary tumor in the medulla oblongata. The features of the clinical presentation, magnetic resonance (MRI) appearances, and management strategy are discussed. CASE PRESENTATION A 59-year-old man without evidence of systemic sarcoidosis was presented with a history of progressive numbness and deep sensation disturbance in bilateral lower extremities. MR imaging revealed an enhanced intra-axial mass lesion on the dorsal side of medulla. Under neurophysiological monitoring, tumor biopsy was performed. Pathologic evaluation revealed noncaseating granuloma composed of large epithelioid cells with multinucleated giant cells, suggesting sarcoidosis. Findings of comprehensive hematologic laboratory studies; cerebrospinal fluid examination; and examinations for bacteria, fungi, and acid fast bacilli were all negative. This mass lesion was diagnosed as medullary neurosarcoidosis, and then high-dose steroid therapy was tried. On follow-up, nearly complete resolution of the neurosarcoidosis on MRI was revealed. CONCLUSION To our knowledge, this is the first reported case of neurosarcoidosis manifested in the medulla oblongata. A biopsy is sufficient for a diagnosis and high-dose steroid is recommended.
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Colombe B, Derradji M, Bosseray A, Massot C, Debru JL. [Chronic meningitis: aetiologies, diagnosis and treatment]. Rev Med Interne 2003; 24:24-33. [PMID: 12614855 DOI: 10.1016/s0248-8663(02)00002-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE Chronic meningitis are very uncommon and account for less than 10% of all meningitis cases. Their symptoms are uncunth and there outcome is insidious. Therefore, they remain often unknown. There are only a few published reports on this disease, so diagnosis and therapeutic approachs are difficult. CURRENT KNOWLEDGE AND KEY POINTS Positive chronic meningitis diagnosis is easy. However, determining the cause of chronic meningitis remains dilemma, as many infectious and noninfectious processes (including inflammatory, neoplastic or autoimmune aetiologies or as a result of a chemical exposure) can result in the chronic meningitis syndrome. In order to institute a pertinent treatment, sometimes urgently needed, diagnostic approach must be extremely rigourous and accutely orientated. Nevertheless, although extensive investigations, 30% of the aetiologies remain undetermined. Only two choices are left for the medical physician: an aggressive attitude based on complementary investigations or a contemplated therapy with a close clinical and biological control. On the other hand, when the patient's condition is quickly deterioring without a clear and proved aetiology, it is sometimes necessary to institute an empirical treatment, not always properly determined and sometimes contreversial. Besides, few reports on prognosis and outcome od idiopathic chronic meningitis have been published. FUTURE PROSPECTS AND PROJECTS After a review of aetiologies and diagnostic investigations chronic meningitis, we propose a practical experience attitude about management and treatment of chronic meningitis. Thus, large-scale studies about the follow up chronic meningitis in long term, in particular those without aetiology, treated or no, should improve the outcome of this chronic syndrome.
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Affiliation(s)
- B Colombe
- Département pluridisciplinaire de médecine, centre hospitalo-universitaire de Grenoble, France.
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19
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Abstract
Classical descriptions of the temporal bone are based on its five embryologically distinct osseous components: the petrous, tympanic, mastoid, squamous, and styloid portions.
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Affiliation(s)
- H Christian Davidson
- Veterans Affairs Salt Lake City Health Care System, University of Utah, Department of Radiology, 500 South Foothill Drive, Salt Lake City, UT 84148, USA.
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20
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Kaliszky Z, Walker A, Tyor WR. Therapeutic options in neurosarcoidosis. Expert Rev Neurother 2002; 2:703-8. [PMID: 19810986 DOI: 10.1586/14737175.2.5.703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Neurosarcoidosis is an uncommon disorder that requires careful clinical evaluation to reach the diagnosis. It may involve the CNS and peripheral nervous system and in the majority of cases it is associated with systemic disease. The demonstration of the activity of the immune system, as suggested by routine and immunopathological studies, forms a theoretical basis for the common forms of immunosuppressive therapies that are employed in sarcoidosis. Classic treatment consists of steroids either intravenously or orally. In refractory cases or in order to reduce or eliminate steroids, methotrexate, cyclophosphamide, azathioprine, cyclosporin, chlorambucil, chloroquine and hydroxychloroquine use may be an option.
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Affiliation(s)
- Zoltan Kaliszky
- Medical University of South Carolina, Department of Neurology, Charleston, South Carolina 29425, USA.
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21
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Abstract
Neurosarcoidosis is an uncommon disorder and requires a careful clinical evaluation to reach a diagnosis. Generally, patients with peripheral symptoms, which include paresthesias, painful patches over extremities, and stocking glove deficits, have a better outcome when compared with those with central nervous system (CNS) involvement. Patients with mass lesions or hydrocephalus tend to have more relapses and are often more resistant to routine therapy. Neurosarcoidosis often responds to glucocorticoids, usually within days or weeks of initiating therapy. Patients are usually maintained on 40 to 80 mg per day for 4 to 6 weeks, then tapered slowly. The use of alternative treatments for refractory neurosarcoidosis, or to reduce or eliminate steroids, includes methotrexate, cyclophosphamide, azathioprine, cyclosporine, chlorambucil, chloroquine, and hydroxychloroquine.
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Affiliation(s)
- Aljoeson Walker
- *Neurology Service, Ralph H. Johnson VA Medical Center, 109 Bee Street, Charleston, SC 29401, USA.
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Abstract
The imaging evaluation of patients with sensorineural hearing loss (SNHL) focuses on the acoustic pathways from the cochlea to the auditory cortex. Magnetic resonance imaging (MRI) is the modality of choice for most patients with SNHL, though computed tomography (CT) also plays an important role in the evaluation of bony changes and in patients for whom MRI is contraindicated. Conventional enhanced MRI is the most commonly used technique in this clinical setting. High-resolution fast spin-echo T2 MRI is an adjunctive technique that provides exquisite evaluation of the cerebellopontine angle (CPA), internal auditory canal (IAC), cranial nerves, and membranous labyrinth, and plays a significant role in the diagnosis and surgical evaluation of SNHL. Categories of lesions that cause SNHL include brain lesions involving central auditory pathways; neoplasms of the CPA and IAC, the most common being schwannoma; other neoplastic, congenital, and cystic masses of the CPA and IAC; congenital anomalies of the inner ear; intrinsic cochlear nerve defects, inflammatory processes of the inner ear; and temporal bone trauma.
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Affiliation(s)
- H C Davidson
- VA Salt Lake City Health Care System, Department of Radiology, University of Utah Health Sciences Center, 84148, USA
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23
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Amatya VJ, Takeshima Y, Sugiyama K, Yokozaki H, Inai K. Idiopathic granulomatous meningoencephalitis presenting as an intracranial tumor. Pathol Int 1999; 49:1084-8. [PMID: 10632929 DOI: 10.1046/j.1440-1827.1999.00981.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A 2-year-old girl presented with a single episode of generalized seizure. Magnetic resonance imaging examination showed an intracranial mass with a diameter of 2.5 cm in the right parieto-occipital region of the cerebrum. These clinicoradiological findings were suggestive of intracranial tumor. Histologically, fibroblastic proliferation of storiform pattern was noted, associated with epithelioid granulomas. The etiological pathogens for the granulomas could not be detected even though investigation of special histochemical staining, immunohistochemical study and DNA analysis of Mycobacterium tuberculosis by polymerase chain reaction technique was performed. On electron microscopic examination, the area appearing as a storiform pattern consisted of fibroblasts showing much dilated rough endoplasmic reticulum and slender tappering cytoplasmic processes without cellular junctional complex. No organisms were identified in the granulomatous area of the lesion. From those findings the diagnosis as idiopathic granulomatous meningoencephalitis was made.
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Affiliation(s)
- V J Amatya
- Second Department of Pathology, University School of Medicine, Hiroshima, Japan
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Abstract
We present three new and 14 retrospective cases of polyradiculopathy in sarcoidosis. Of these, 71% had weakness and 59% areflexia of the lower extremities, and 35% had sphincter dysfunction. Cases often were associated with central nervous system sarcoidosis. All cases involved thoracolumbar or lumbosacral roots, except a single case of cervical polyradiculopathy. Of 14 treated patients, nine improved with corticosteroids, laminectomy, or both. Polyradiculopathy complicating sarcoidosis: (1) is uncommon; (2) primarily involves thoracic and lumbar roots; (3) may arise from contiguous, hematogenous, or gravitational nerve root sleeve seeding; (4) may be asymptomatic; and (5) may improve with corticosteroids. Differential diagnosis of weakness in patients with sarcoidosis should include nerve root involvement from the primary process by direct sarcoid involvement.
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Affiliation(s)
- B Koffman
- Department of Neurology, Henry Ford Hospital and Health Sciences Center, Detroit, Michigan 48202-2689, USA
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25
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Fain O, Seror O, Wirth JF, Heron C, Mathieu E, Chamouard JM, Guillevin L, Thomas M. [Cranial pachymeningitis]. Rev Med Interne 1999; 20:234-46. [PMID: 10216880 DOI: 10.1016/s0248-8663(99)83051-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Pachymeningitis is a fibrous inflammatory process with non-specific symptoms, involving the dura mater. Due to MRI development, diagnosis is both easier and earlier. CURRENT KNOWLEDGE AND KEY POINTS We report seven cases and review current literature. Clinical features are headaches and cranial nerve palsies. CSF shows inflammatory changes, while MRI evidences thickening of the dura mater. Disease etiologies in the present study were tuberculosis in two cases, sarcoidosis, Lyme disease, lymphoma and dural puncture; in one case only the disease was of unknown origin. The condition of six patients improved with specific treatment. FUTURE PROSPECTS AND PROJECTS Further MRI development should allow detection of new forms of pachymeningitis and standardization of patients' management through the study of more important series.
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Affiliation(s)
- O Fain
- Service de médecine interne, hôpital Jean-Verdier, Bondy, France
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26
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Abstract
The differential diagnosis of nonpituitary sellar masses is broad; differentiating among potential etiologies may not always be straightforward because many of these lesions, tumorous and nontumorous, may mimic the clinical, endocrinologic, and radiologic presentations of pituitary adenomas. This article provides an overview of the clinical and radiographic characteristics of both pituitary tumors and the nonpituitary lesions found in the sellar/parasellar region and discusses, in detail, the specific nonpituitary origins of the sellar masses.
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Affiliation(s)
- P U Freda
- Department of Medicine, Columbia College of Physicians and Surgeons, New York, New York, USA
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Matsumoto K, Awata S, Matsuoka H, Nakamura S, Sato M. Chronological changes in brain MRI, SPECT, and EEG in neurosarcoidosis with stroke-like episodes. Psychiatry Clin Neurosci 1998; 52:629-33. [PMID: 9895212 DOI: 10.1111/j.1440-1819.1998.tb02711.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Neurosarcoidosis with recurrent stroke-like episodes has been reported only rarely in the literature. We repeatedly measured brain magnetic resonance images (MRI), SPECT, and electroencephalograms (EEG) in a 32-year-old male patient with this condition. In the acute stage of the episodes, he showed semi-coma followed by severe dysphasia; left-frontal EEG delta wave activities and left-sided hyperperfusion SPECT were noted. Gadolinium diethylenetriaminepentaacetic acid (Gd-DTPA) MRI findings were aggravated diffusely in the convalescent stage of the disease rather than in the acute stage. The EEG and SPECT findings were clearly reflective of an early stage of acute encephalomeningitis caused by the neurosarcoidosis, and thus are more useful than MRI for evaluation of the acute inflammatory process in this condition.
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Affiliation(s)
- K Matsumoto
- Department of Psychiatry, Tohoku University School of Medicine, Sendai, Japan.
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Lipper MH, Goldstein JM. Neurosarcoidosis mimicking a cerebellopontine angle meningioma. AJR Am J Roentgenol 1998; 171:275-6. [PMID: 9648818 DOI: 10.2214/ajr.171.1.9648818] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- M H Lipper
- University of Virginia Health Sciences Center, Charlottesville 22908, USA
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Hsu YY, Wang CR, Yeoh HA, Lin JL. Endovascular retrieval of an embolized central venous catheter in a neonate of very low birth weight. AJR Am J Roentgenol 1998; 171:276-7. [PMID: 9648819 DOI: 10.2214/ajr.171.1.9648819] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Y Y Hsu
- Chang Gung Memorial Hospital, Taipei, Taiwan, Republic of China
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Wynne PJ, Younger DS, Khandji A, Silver AJ. Radiographic features of central nervous system vasculitis. Neurol Clin 1997; 15:779-804. [PMID: 9367964 DOI: 10.1016/s0733-8619(05)70347-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Central nervous system (CNS) vasculitis refers to primary and secondary disorders of the CNS vasculature. Most authorities agree that CNS vasculitis is a potentially serious disorder; therefore, prompt diagnosis and initiation of therapy are high priorities in treatment. Remarkable progress has been made in the diagnosis, evaluation, and treatment of this disorder. This article examines many aspects of the radiographic evaluation of CNS vasculitis.
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Affiliation(s)
- P J Wynne
- Department of Radiology, Division of Neuroradiology, Columbia-Presbyterian Medical Center, New York, New York 10032, USA
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Mombaerts I, Schlingemann RO, Goldschmeding R, Koornneef L. Idiopathic granulomatous orbital inflammation. Ophthalmology 1996; 103:2135-41. [PMID: 9003349 DOI: 10.1016/s0161-6420(96)30378-3] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Granulomatous orbital inflammation may occur as an isolated condition of unknown origin. These idiopathic granulomatous lesions are believed to belong to the orbital pseudotumor group by some authors, whereas others consider them sarcoidosis limited to the orbit. The aim of this study is to define the clinicotherapeutic aspects of these lesions. METHODS The records of all patients with diagnosis of orbital pseudotumor and orbital sarcoidosis from the Orbital Center Amsterdam in the period between 1976 and 1994 were reviewed to define those with idiopathic granulomatous orbital inflammation. The authors studied the clinicotherapeutic aspects and histopathology of idiopathic granulomatous orbital inflammation by analysis of their own series and the literature. RESULTS Their study group encompassed seven patients with idiopathic granulomatous orbital inflammation. The mean follow-up was 9.5 years (range, 3.5-16.0 years). All had unilateral orbital presentation, with localization in the lacrimal gland in three patients. The lesions clinically presented with signs of mass effect or inflammation or both and were treated successfully with surgery, systemic corticosteroids, a combination of surgery and systemic corticosteroids, or systemic corticosteroids followed by irradiation. Histopathologic analysis showed a spectrum of granulomatous inflammation, admixed with nongranulomatous inflammation and fibrosis. There have been 30 similar cases described in the literature with comparable clinicotherapeutic characteristics. CONCLUSIONS Based on this study and the literature, it appears that idiopathic granulomatous orbital inflammation is more related to orbital pseudotumor than to orbital sarcoidosis.
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Affiliation(s)
- I Mombaerts
- Department of Ophthalmology, Academic Medical Center, University of Amsterdam, The Netherlands
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