Hoyle J Chad, Jablonski Courtney, Newton Herbert B
Department of Neurology, Wexner Medical Center, The Ohio State University, Columbus, OH, USA.
Department of Internal Medicine, Wexner Medical Center and Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA ; Department of Pediatrics, Wexner Medical Center and Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA.
Neurohospitalist. 2014 Apr;4(2):94-101. doi: 10.1177/1941874413519447.
Neurosarcoidosis is frequently on the differential diagnosis for neurohospitalists. The diagnosis can be challenging due to the wide variety of clinical presentations as well as the limitations of noninvasive diagnostic testing. This article briefly touches on systemic features that may herald suspicion of this disorder and then expands in depth on the neurological clinical presentations. Common patterns of neurological presentations are reviewed and unusual presentations are also included. A discussion of noninvasive testing is undertaken, exploring dilemmas that may be encountered with sensitivity and specificity. Drawing from a broad range of clinical clues and diagnostic data, a systematic approach of pursuing a potential tissue diagnosis is then highlighted. Correctly diagnosing neurosarcoidosis is critical, as treatment with appropriate immunosuppression protocols can then be initiated. Additionally, treatment of refractory disease, the trend toward exploring targeted immunomodulation options, and other therapeutic issues are discussed.
神经结节病常常在神经科医生的鉴别诊断范围内。由于临床表现多种多样以及无创诊断检测存在局限性，该疾病的诊断颇具挑战性。本文简要提及可能提示怀疑该疾病的全身特征，然后深入阐述神经科临床表现。回顾了神经科表现的常见模式，也包括不寻常的表现。对无创检测进行了讨论，探讨了在敏感性和特异性方面可能遇到的难题。基于广泛的临床线索和诊断数据，强调了寻求潜在组织诊断的系统方法。正确诊断神经结节病至关重要，因为随后可以启动适当的免疫抑制方案进行治疗。此外，还讨论了难治性疾病的治疗、探索靶向免疫调节方案的趋势以及其他治疗问题。
