Neurology, Aster MIMS, Calicut, India
Neurosurgery, Meitra Hospital, Calicut, India.
BMJ Case Rep. 2022 May 17;15(5):e247792. doi: 10.1136/bcr-2021-247792.
We present a unique case of biopsy-proven necrotising sarcoidosis involving the central nervous system in a man in his 40s. The patient presented with a 2-week history of right-sided headache and diplopia. He had right trochlear and abducens nerve palsy, sensory blunting over V1 and V2 segment of right trigeminal sensory nerve and right sensory neural hearing loss. A contrast-enhanced MRI revealed an enhancing dural-based mass lesion in the petroclival area suggestive of probable meningioma. Surgical resection was attempted and intraoperative consultation with frozen section revealed granulomata. So, the lesion was biopsied and surgical intervention was terminated. A diagnosis of necrotising neurosarcoidosis was confirmed on histopathology. He was treated with steroids after excluding other causes of intracranial necrotising granulomas like tuberculosis and he clinically responded favourably. We report one of the very few case reports of histologically proven necrotising sarcoidosis involving the central nervous system mimicking petroclival meningioma.
我们报告了一例独特的活检证实的中枢神经系统坏死性类肉瘤病病例，涉及一名 40 多岁的男性。该患者出现右侧头痛和复视，病史为 2 周。他有右侧滑车神经和外展神经麻痹，右侧三叉神经感觉神经 V1 和 V2 段感觉迟钝和右侧感觉性神经性听力损失。增强 MRI 显示岩斜坡区增强硬脑膜基底部肿块病变，提示脑膜瘤可能性大。尝试进行手术切除，冰冻切片的术中咨询显示肉芽肿。因此，对病变进行了活检，手术干预终止。组织病理学证实为坏死性神经类肉瘤病的诊断。在排除颅内坏死性肉芽肿的其他原因（如结核）后，他接受了类固醇治疗，临床反应良好。我们报告了极少数经组织学证实的中枢神经系统坏死性类肉瘤病病例之一，该病例模仿岩斜坡脑膜瘤。
