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Pojen Deng, Olga Krasnozhen-Ratush, Christopher William, Jonathan Howard
Spinal neurosarcoidosis is a rare form of neurosarcoid which can be challenging to diagnose given its clinical or radiographic findings are often indistinguishable from other causes of spinal demyelinating disease. We present a series of three patients with spinal neurosarcoid, all of whom demonstrated concurrent longitudinally enhancing transverse myelitis as well as spinal nerve root enhancement. These findings may be suggestive of spinal neurosarcoid and may help clinicians make the diagnosis as well as reduce the need for invasive biopsy...
May 1, 2018: Multiple Sclerosis: Clinical and Laboratory Research
Michael Thambuswamy, Ashish H Shah, Mai Tran, Joanne T Thambuswamy, Amade Bregy, Michael D Norenberg, Ricardo J Komotar
Isolated neurosarcoidosis without prior systemic symptoms is extremely rare, occurring in approximately 2% of patients with neurosarcoidosis. Due to its rarity, mistakes in diagnosis and treatment occur commonly. We present a case of a 47-year-old female who was found to have an incidentally discovered solitary intracranial lesion that mimicked a high-grade neoplasm, but was later confirmed to be neurosarcoidosis. Incidental solitary neurosarcoid granulomas are difficult to diagnose due to its nonspecific clinical and imaging presentations...
July 2017: Asian Journal of Neurosurgery
Iman Khodarahmi, Roger E Turbin, Larry P Frohman, Nasrin Ghesani
While the imaging modality of choice to diagnose neurosarcoidosis is gadolinium-enhanced MRI, F-FDG PET/CT maybe used to stage the disease or target the optimal biopsy site. Few cases have described intense F-FDG uptake at the sites of active neurosarcoidosis in the midbrain and pituitary gland, cerebellar hemispheres, and temporal lobes. Here, we present a case of neurosarcoidosis whose PET/CT examination demonstrated F-FDG avidity in a dural plaque.
September 2016: Clinical Nuclear Medicine
M Breckwoldt, M Bendszus
CLINICAL/METHODICAL ISSUE: Melanoma is the third leading cancer entity to metastasize to the central nervous system (CNS) after lung and breast cancer. This is often an early event in the disease course and limits survival. Metastasis in the CNS is the cause of death in 10-40 % of melanoma patients and the incidence of brain metastasis is even higher (50-75 %). Cerebral metastases are commonly found in the subcortical white matter. The signal characteristics can vary substantially and may change over time due to hemorrhages or the accumulation of melanin and paramagnetic ions...
February 2015: Der Radiologe
Arvind K Badhey, Sameep Kadakia, Ricardo L Carrau, Codrin Iacob, Azita Khorsandi
Sarcoidosis is a complex disorder that often times involves the head and neck. Despite the presence of strong clinical evidence, tissue diagnosis and imaging is needed for confirmation of the disease. Although typically managed medically, when found in the sinonasal tract or intracranially, it may necessitate the intervention of a rhinologist-skull base surgeon. This article seeks to provide a comprehensive review of head and neck sarcoidosis, as this fascinating disorder often poses a diagnostic and therapeutic challenge...
June 2015: Head and Neck Pathology
Eoin P Flanagan, Christopher H Hunt, Val Lowe, Jay Mandrekar, Sean J Pittock, Brian Patrick O'Neill, B Mark Keegan
OBJECTIVE: To report and compare spinal cord [(18)F]-fluorodeoxyglucose-positron emission tomography (FDG-PET) metabolism in 51 patients with active myelopathy. PATIENTS AND METHODS: We retrospectively identified patients from January 1, 2001, through December 31, 2011, with active myelopathy in whom FDG-PET was performed. Inclusion criteria were (1) intramedullary myelopathy, (2) neoplastic/inflammatory etiology, and (3) FDG-PET performed after myelopathy onset...
November 2013: Mayo Clinic Proceedings
S Braksick, S Shah-Haque, B El-Haddad, R Moussa
Sarcoidosis is a granulomatous disease that can present systemically, but primarily has pulmonary manifestations. It is reported across all races, but has a higher incidence among African Americans. Neurological involvement in sarcoidosis is rare, with cranial nerve seven being the most commonly reported neurological finding. Trigeminal neuralgia, as presented in this case, is very rare. A 38-year-old African American female, with history of refractory trigeminal neuralgia, cutaneous sarcoidosis, and an extensive psychiatric history, presented to the hospital for fifth cranial nerve decompression...
August 1, 2013: Sarcoidosis, Vasculitis, and Diffuse Lung Diseases: Official Journal of WASOG
Daisuke Kobayashi, Kelly Rouster-Stevens, Amy Harper
Childhood neurosarcoidosis is rare, and its etiology is unknown. La Crosse virus is one of the most common causes of encephalitis in North America. We report the case of a 12-year-old boy who had La Crosse virus encephalitis and subsequently developed imaging and pathologic findings suggestive of neurosarcoidosis. He presented with acute onset of transient aphasia 4 months after an episode of encephalitis; serology results at the time of aphasia were positive for La Crosse virus. Brain MRI revealed diffuse subcortical nodular lesions...
April 2011: Pediatrics
Elske Hoitsma, Marjolein Drent, Om P Sharma
PURPOSE OF REVIEW: Neurosarcoidosis may be a serious complication of sarcoidosis. As the presentation of neurosarcoidosis is manifold, solitary nervous system sarcoidosis without systemic activity remains a difficult diagnosis. Appropriate treatment may be a dilemma. RECENT FINDINGS: Most neurosarcoidosis patients present with neurological symptoms as the first manifestation. Whole-body fluorodeoxyglucose positron emission tomography has been found useful in neurological patients suspected of sarcoidosis...
September 2010: Current Opinion in Pulmonary Medicine
Rebecca Straus Farber, Laetitia Devilliers, Aaron Miller, Fred Lublin, Meng Law, Girish Fatterpekar, Bradley Delman, Thomas Naidich
PURPOSE: To compare diffusion weighted imaging metrics in gray and white matter brain regions of patients diagnosed with multiple sclerosis (MS) to those diagnosed with secondary demyelinating diseases such as neurosarcoid and acute disseminated encephalomyelitis (ADEM). MATERIALS AND METHODS: Diffusion weighted scans were performed and apparent diffusion coefficients of 12 regions of interest were determined in 30 MS patients, 21 neurosarcoid patients, and 4 ADEM patients...
October 2009: Journal of Magnetic Resonance Imaging: JMRI
S Pawate, H Moses, S Sriram
OBJECTIVE: To report on the clinical presentations, laboratory abnormalities, treatment and outcomes in 54 patients with neurosarcoidosis (NS). BACKGROUND: Sarcoidosis is an inflammatory granulomatous disease affecting multiple organ systems. Neurosarcoidosis (CNS involvement) is seen in approximately 25% of patients with systemic sarcoidosis, although it is subclinical in most of these cases. Because of its rarity, exposure of neurologists to the clinical spectrum of NS is limited to case reports or short case series...
July 2009: QJM: Monthly Journal of the Association of Physicians
Franklin D Westhout, Mark E Linskey
BACKGROUND: Neurosarcoidosis presents with meningitis, cranial nerve involvement, and parenchymal masses. Usually, abnormal MR enhancement and/or structural lesion(s) are present. Communicating hydrocephalus arises from meningeal arachnoid granulation involvement. Reported cases of obstructive hydrocephalus have all involved obstructing ventricular lesions. CASE DESCRIPTION: A 40-year-old African American man presented with papilledema, diplopia, and headache. Magnetic resonance imaging revealed "aqueductal stenosis" without abnormal enhancement or obstructive lesion...
March 2008: Surgical Neurology
R B Libman, S Sharfstein, W Harrington, P Lerner
BACKGROUND: Sarcoid affecting the central nervous system may cause granulomatous angiitis. Nevertheless, neurosarcoid manifesting as intracerebral hemorrhage has been infrequently reported. CASE DESCRIPTION: A 48-year-old woman with systemic sarcoid developed recurrent intracerebral hemorrhages culminating in death despite treatment with corticosteroids. Pathological examination of the brain revealed inflammatory changes of blood vessels including multinucleated giant cells...
July 1997: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
J M Markert, K Powell, R S Tubbs, K O Riley, M N Hadley, C A Palmer
BACKGROUND: Neurosarcoid affects approximately 5% of patients with sarcoidosis. A significantly more rare entity, necrotizing sarcoidosis affecting the central nervous system, has been confirmed previously in only three case reports. This paper documents three additional cases of necrotizing neurosarcoid, involving a wide spectrum of central nervous system (CNS) locations. RESULTS: One patient presented to the emergency department after being found unresponsive...
March 2007: Clinical Neuropathology
J E Arle, A R Judkins, M J Kotapka
Two cases of neurosarcoidosis in the pituitary gland are presented with a review of past cases from the literature. Previous reported cases have always shown changes on the ondocrine exis clinically. These two cases, however, were endocrinologically normal prior to surgery. The evaluation of neurosarcoid in the pituitary, clinically and radiographically, is discussed.
1999: Skull Base Surgery
Jonathan L Brisman, Archana Hinduja, James S McKinney, Brian Gerhardstein
BACKGROUND: Sarcoidosis is a systemic disease with neurologic involvement in approximately 5% of cases. Ischemic events related to neurosarcoid vasculitis are rare. We report the successful treatment of symptomatic neurosarcoid vasculitis with angioplasty. CASE DESCRIPTION: A 41-year-old African American with a diagnosis of neurosarcoid presented with aphasia and right-sided weakness. He was treated medically with antiplatelet agents, heparinization, and hypertensive therapy...
October 2006: Surgical Neurology
Robert J Baumann, William C Robertson
BACKGROUND: Neurosarcoid is seldom recognized in children. In the absence of any large pediatric series, it has been assumed that the presenting signs and symptoms are identical in adults and children. OBJECTIVE: To test the hypothesis that childhood neurosarcoid differs in presenting signs and symptoms from neurosarcoid in adults. METHODS: We tabulated the initial neurologic signs and symptoms in all reported cases of childhood sarcoid with evidence of central nervous system involvement...
December 2003: Pediatrics
K Okamoto, J Ito, K Ishikawa, K Sakai, S Tokiguchi
We assess diffusion-weighted MR images in the differential diagnosis of intracranial brain tumors and tumor-like conditions. Heavily diffusion-weighted (b = 1100 or 1200 s/mm2) axial images were obtained with single-shot echo-planar technique in 93 patients with pathologically confirmed various intracranial tumors and tumor-like conditions with diffusion gradient perpendicular to the images. We compared signal intensity of the lesions with those of gray and white matter, and cerebrospinal fluid (CSF). In 29 cases (31...
2000: European Radiology
M S Guoth, J Kim, A C de Lotbiniere, M L Brines
We report a young woman with clinical hypopituitarism and systemic sarcoidosis involving the lung, gastrointestinal tract, and peripheral lymph nodes. Laboratory evaluation confirmed that cortisol, thyroid indices, insulin-like growth factor 1, follicle-stimulating hormone, luteinizing hormone, and estradiol levels were low, with a normal prolactin. Magnetic resonance imaging revealed a large cystic pituitary lesion compressing the optic chiasm and exhibiting rim but not hypothalamic enhancement. The differential diagnosis included cystic macroadenoma, Rathke's cleft cyst, craniopharyngioma, and simple cyst...
March 1998: American Journal of the Medical Sciences
A H Maniker, E S Cho, M Schulder
BACKGROUND: Neurosarcoid is known to develop in 5% of patients with sarcoidosis. A frequent manifestation of this condition is hydrocephalus, which will often require treatment with a ventricular shunt. METHODS: Presented here is the case of a patient whose initial manifestation of neurosarcoidosis was hydrocephalus, and who then represented with multiple shunt failures. RESULTS: On two revisions, the proximal catheter, after removal, was found to be occluded with noncaseating granulomatous material that had infiltrated the shunt lumen...
November 1997: Surgical Neurology
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