Mahadewa Tjokorda G B, Nakagawa Hiroshi, Watabe Takeya, Inoue Tatsushi
Department of Neurological Surgery, Aichi Medical University, Aichi, Japan.
Surg Neurol. 2004 Mar;61(3):283-7; discussion 287. doi: 10.1016/S0090-3019(03)00398-7.
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.
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.
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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