Feizi Parissa, Tandon Medha, Khan Erum, Subedi Roshan, Prasad Apoorv, Chowdhary Anisa, Sriwastava Shitiz
Department of Neuroradiology, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV 26505, USA.
Safdarjung Hospital, New Delhi 110029, India.
Neurol Int. 2021 Mar 25;13(2):130-142. doi: 10.3390/neurolint13020013.
The involvement of the central nervous system in sarcoidosis can manifest with a variety of neurological symptoms, and most of them can be nonspecific. The diagnosis of neurosarcoidosis (NS) can therefore be very challenging without a tissue biopsy. Both computed tomography (CT) and magnetic resonance imaging (MRI) are important imaging modalities in the diagnosis of NS, and MRI is the modality of choice due to its superior soft-tissue contrast resolution. We present a case series of NS with interesting neuroimaging features, complex neurological presentations, and clinical courses. We identify five cases presenting with clinically isolated neurosarcoidosis (CINS) without any other signs or symptoms of systemic disease which were diagnosed as NS on biopsy. In the first case, we describe a patient with an intramedullary cervical spinal cord lesion. In the second case we describe a patient presenting with inflammatory changes and enhancement in the orbit. The third case demonstrates a lesion with calcification around the region of the foramen of Monro. The fourth case shows multiple ring-enhancing lesions. Lastly, the fifth case exhibits unusual findings with both optic neuritis and a cerebellar nodule. We aim to describe the complicated clinical course with neurological workup, neuro-imaging, and eventual diagnosis and treatment of these challenging cases to highlight the variable presentations of NS. This case series will remind clinicians that NS should always be in the differential diagnosis when a patient presents with nonspecific neurological symptoms with unusual neuroimaging findings.
结节病累及中枢神经系统可表现为多种神经症状，且大多数症状可能不具有特异性。因此，在没有组织活检的情况下，神经结节病（NS）的诊断极具挑战性。计算机断层扫描（CT）和磁共振成像（MRI）都是NS诊断中的重要成像方式，而MRI因其卓越的软组织对比分辨率成为首选方式。我们呈现了一组具有有趣神经影像学特征、复杂神经表现和临床病程的NS病例系列。我们确定了5例表现为临床孤立性神经结节病（CINS）且无任何其他全身性疾病体征或症状的病例，这些病例经活检诊断为NS。在第一个病例中，我们描述了一名患有颈髓髓内病变的患者。在第二个病例中，我们描述了一名眼眶出现炎症改变和强化的患者。第三个病例显示在孟氏孔区域周围有一个伴有钙化的病变。第四个病例显示多个环形强化病变。最后，第五个病例呈现出视神经炎和小脑结节的异常表现。我们旨在描述这些具有挑战性病例的复杂临床病程，包括神经检查、神经影像学检查以及最终的诊断和治疗，以突出NS的多样表现。这个病例系列将提醒临床医生，当患者出现具有不寻常神经影像学表现的非特异性神经症状时，NS应始终列入鉴别诊断。
