Department of Neurology, Concord Hospital, University of Sydney, NSW, Australia.
Department of Immunology, Concord Hospital, University of Sydney, NSW, Australia.
J Neuroimmunol. 2022 Aug 15;369:577904. doi: 10.1016/j.jneuroim.2022.577904. Epub 2022 Jun 2.
Neurosarcoidosis is an important diagnosis to exclude in the work-up for suspected multiple sclerosis (MS). The distinction between the two conditions is usually possible due to characteristic clinical manifestations, magnetic resonance imaging (MRI) findings, and the results of other supportive investigations such as CT-PET. Definitive diagnosis can be made by histopathological examination, but this is not always practical. Misdiagnosis can occur when the clinical characteristics and MRI findings of both conditions overlap. Those patients with characteristic findings of MS but extraneural histopathological evidence of sarcoidosis are a particularly difficult diagnostic group. Diagnostic clarity is essential to inform treatment, especially as certain treatments for one disorder can exacerbate the other. This article summarises the clinical, laboratory and radiological findings that aid the clinician in distinguishing between the two conditions. It also discusses the literature on the potential for sarcoidosis and MS to co-exist in some patients, and how to approach the treatment of these "overlap" patients.
神经结节病是疑似多发性硬化症 (MS) 患者需要排除的重要诊断。这两种疾病通常可以通过特征性的临床表现、磁共振成像 (MRI) 结果以及 CT-PET 等其他支持性检查的结果来区分。通过组织病理学检查可以做出明确诊断，但这并不总是可行的。当两种疾病的临床特征和 MRI 结果重叠时，可能会出现误诊。那些具有 MS 特征性发现但有神经外组织病理学证据的结节病患者是一个特别具有挑战性的诊断群体。明确诊断对于指导治疗至关重要，特别是因为一种疾病的某些治疗方法可能会使另一种疾病恶化。本文总结了有助于临床医生区分这两种疾病的临床、实验室和影像学发现。它还讨论了结节病和 MS 在某些患者中同时存在的文献，并探讨了如何治疗这些“重叠”患者。
