1/99. central nervous system sarcoidosis--diagnosis and management.A series of 68 patients with neurosarcoidosis is reported, with particular emphasis on clinical aspects, diagnosis and treatment. A classification system based on clinical diagnostic probability is proposed, consisting of probable and definite disease, the latter being dependent on finding sarcoid granulomas on nervous system histology, which was obtained in 12 patients (18%). The role of investigations, including magnetic resonance imaging (MRI), chest radiography, Kveim skin test, gallium 67 isotope scanning and cerebrospinal fluid (CSF) studies, is considered. Sixty-two percent of patients presented with nervous system disease, most commonly affecting the optic nerve and chiasm. Other common presentations included cranial nerve palsies, spinal cord and brainstem manifestations. Investigations yielding most diagnostic information included the kveim test (41/48, 85% positive), raised CSF protein and/or cells (50/62, 81%) and gallium 67 scan (14/31, 45%). Eleven out of 29 patients (38%) patients showed meningeal enhancement on MRI scanning and 43% of scans demonstrated multiple white-matter lesions. Mean follow-up for the group was 4.6 years. Forty-seven patients were seen for > 18 months, and over half of these patients progressed despite corticosteroid and other immunosuppressive therapies. The benefit of a large patient database prospectively studied, with extended follow-up is discussed in order to learn more about prognosis and advance therapy in neurosarcoidosis.- - - - - - - - - - ranking = 1keywords = spinal (Clic here for more details about this article) |
2/99. spinal cord sarcoidosis presenting as an intramedullary mass: a case report.A case of spinal cord sarcoidosis mimicking an intramedullary tumor is reported because of its rarity and difficulty in diagnosis before surgery. A 66-year-old woman began to suffer from chronic thoracic myelopathy in August, 1996. She had a history of intrathoracic sarcoidosis with left hilar adenopathy in 1991, which disappeared completely after steroid therapy for one month. magnetic resonance imaging of the T-spine performed on 4 June, 1997, showed normal appearance in T1-weighted and T2-weighted images but abnormal enhancement at the T10-11 level. Open biopsy revealed noncaseating granulomatous inflammation and perivascular lymphocytic infiltration. Following biopsy, methylprednisolone 750 mg was given daily for three days followed by prednisolone 60 mg per day. The patient was discharged on 10 July, 1997, in a stable condition. She died on 22 July, 1997, at a local hospital due to urinary tract infection with sepsis.- - - - - - - - - - ranking = 0.5keywords = spinal (Clic here for more details about this article) |
3/99. spinal cord granulomatous vasculitis: an unusual clinical presentation of sarcoidosis.A 52-year-old Caucasian man presented with isolated manifestations of myelopathy. Cervical magnetic resonance imaging showed a focus of increased signal intensity at the posterolateral left half of C5 and C6. biopsy of spinal cord revealed the presence of active vasculitis associated with noncaseating granulomas. The patient responded to the combination of methotrexate (MTX) and corticosteroid treatment. Low-dose MTX was an effective, steroid-sparing regimen. This is a rare condition of isolated spinal cord involvement associated with sarcoid vasculitis.- - - - - - - - - - ranking = 1keywords = spinal (Clic here for more details about this article) |
4/99. cryptococcosis during systemic glucocorticosteroid treatment.cryptococcosis is an opportunistic infection caused by a fungus, cryptococcus neoformans. It is usually seen in immunocompromised patients with AIDS, leukaemia, lymphoma, sarcoidosis or immunosuppressive treatments. We describe a patient who was treated with systemic glucocorticosteroids for 4 years because of lung sarcoidosis. During the last year of treatment, a papular eruption developed which later became ulcerative. In a histopathological examination of a skin biopsy, there was granulomatous inflammation, and the disease was treated as sarcoidosis without success. After 1 year's unsuccessful treatment, another skin biopsy and skin fungal culture revealed C. neoformans. Cryptococcal antigen was found in blood and cerebrospinal fluid, too. The patient was successfully treated first with an amphotericin-B-flucytosine combination and later with fluconazole.- - - - - - - - - - ranking = 0.5keywords = spinal (Clic here for more details about this article) |
5/99. An MR image of spinal cord sarcoidosis.We present a case of spinal cord sarcoidosis with a unique magnetic resonance imaging (MRI) finding. MRI of the cervical spine revealed an unusual lesion of low signal intensity on T2-weighted image at the core of the lesion surrounded by high signal intensity. T1-weighted gadolinium enhanced image showed a high signal at the core lesion. Low signal intensity on T2-weighted image in the case was suggested to be due to hemosiderin deposition. Steroid therapy dramatically improved clinical symptoms with a marked reduction of peripheral T2 high intensity area and the core lesion size detected by gadolinium enhancement.- - - - - - - - - - ranking = 2.5keywords = spinal (Clic here for more details about this article) |
6/99. Isolated spinal cord sarcoidosis mimicking an intramedullary tumor.A case of cervical intramedullary sarcoidosis and its uncommon magnetic resonance imaging with contrast medium are reported. spinal cord sarcoidosis is very rare. It is difficult to diagnose intramedullary sarcoidosis without a previous diagnosis of systemic sarcoidosis or other apparent symptom. The patient had subacute myelopathy. Contrast-enhanced images revealed intense focal enhancement of the C6-7 cervical cord. The preoperative diagnosis was an intramedullary tumor. Subtotal resection was performed after intraoperative frozen section study was interpreted as malignant lymphoma. Subsequent pathologic examination of the biopsied specimens revealed spinal cord sarcoidosis. After surgery, steroid therapy was performed, but the patient's symptoms hardly improved. Even if imaging study and intraoperative frozen section show neoplasm, the first surgery should be limited to decompressing the cord and biopsy in cases of suspected sarcoidosis.- - - - - - - - - - ranking = 2.5keywords = spinal (Clic here for more details about this article) |
7/99. Micturitional disturbance in a patient with neurosarcoidosis.We report a case of neurosarcoidosis in which urodynamic studies showed neurogenic bladder dysfunction. A 30-year-old man began to have slowly progressive gait ataxia of vestibular origin, deafness, and hallucination, which developed into versive seizure and stupor. brain computed tomography and magnetic resonance imaging showed the anteromedial frontal lobe lesion with mild ventricular enlargement. The cerebrospinal fluid examination revealed pleocytosis with raised total protein and angiotensin-converting enzyme levels. Endoscopic lung biopsy showed epithelioid granuloma. Oral prednislone (60 mg/day) ameliorated his symptoms. After tapering steroids, however, he developed urinary urgency, frequency, urge urinary incontinence, and a relapse of gait ataxia. The urodynamic study showed detrusor hyperreflexia. Prednisolone treatment again improved his urinary and neurological symptoms. The anteromedial frontal lobe lesion seems to be responsible for the micturitional disturbance in our patient with neurosarcoidosis.- - - - - - - - - - ranking = 0.5keywords = spinal (Clic here for more details about this article) |
8/99. Shunt-responsive dementia in sarcoid meningitis: role of magnetic resonance imaging and cisternography.The authors report a patient with progressive cognitive and gait decline in association with sarcoid meningitis. The patient had evidence of active inflammation as determined by cerebrospinal fluid examination and was steroid dependent. magnetic resonance imaging and radionucleotide cisternography were complementary in establishing the diagnosis of communicating hydrocephalus, and suggested that the patient would be shunt responsive.- - - - - - - - - - ranking = 0.5keywords = spinal (Clic here for more details about this article) |
9/99. Extensive leptomeningeal and intraparenchymatous spinal cord neurosarcoidosis.This case of neurosarcoidosis of the spinal cord involved several meningeal areas and spinal cord levels. It appears to be the tenth autopsy-documented case of neurosarcoidosis of the spinal cord, though the patient had more extensive spinal cord disease than has been previously reported.- - - - - - - - - - ranking = 4keywords = spinal (Clic here for more details about this article) |
10/99. Differential response to corticosteroid therapy of MRI findings and clinical manifestations in spinal cord sarcoidosis.spinal cord sarcoidosis is a rare disorder whose natural history and therapeutic outcome are not fully known. We examined four patients with spinal cord sarcoidosis both clinically and radiologically, particularly in relation to corticosteroid treatment. The initial manifestation was cervical myelopathy in three and uveitis in one. All four patients progressed slowly until corticosteroid therapy was initiated. The cervical spine was involved in all patients. magnetic resonance imaging (MRI) who showed spinal cord swelling with T2-weighted high intensity and linear leptomeningeal and patchy or diffuse intramedullary enhancement with gadolinium diethylene triamine-pentaacetic acid. With corticosteroid therapy, dramatic improvement was seen on MRI, including disappearance or marked reduction of swelling and enhancement. plasma levels of angiotensin-converting enzyme (ACE) were also markedly improved. In contrast, the clinical symptoms were little improved in one patient, unchanged in two, and rather worsened in one patient. recurrence was seen on MRI at the maintenance dose in all four patients, without any dramatic change in clinical manifestation. MRI findings and plasma ACE are well correlated with active lesion of the spinal cord sarcoidosis, providing a useful marker for recurrence, but do not parallel the clinical manifestations.- - - - - - - - - - ranking = 3.5keywords = spinal (Clic here for more details about this article) |
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