Imsirovic Bilal, Guso Emir, Omerhodzic Ibrahim, Tawil Adnan Al, Merhemic Zulejha
Polyxlinic "Dr. Al Tawil", Sarajevo, Sarajevo, Bosnia and Herzegovina.
Department of Radiology, General Hospital Prim. Dr. Abdulah Nakas, Sarajevo, Bosnia and Herzegovina.
Acta Inform Med. 2023 Mar;31(1):73-75. doi: 10.5455/aim.2023.31.73-75.
Sarcoidosis is a multisystem granulomatous disease of unknown etiology, characterized by presence of granulomas in affected tissues with variety in clinical presentations and presents a differential diagnostic and therapeutic dilemma. Clinical presentation of neurosarcoidosis is very variable. Diagnosis is based on clinical and radiological criteria and histological findings of disseminated non-necrotic granuloma followed by negative cultures for bacteria and fungi. MRI plays a key role in detection of lesions located in the brain parenchyma.
The aim of this article was to present case of a 36-year-old male patient, who came to doctor with symptoms of fever, dry cough with whitish sputum, lymphadenopathy of neck region and neurological disturbances in form of headaches and vision problems.
Patient underwent on pulmonary examination and results indicated presence of sarcoidosis. CT examination was performed (SIEMENS Somatom Definition AS, Erlangen, Germany), which confirmed presence of mediastinal and hilar lymphadenopathy. Ultrasound (US) examination of a neck region was also performed showed significantly enlarged and morphology altered lymph nodes. After biopsy of several neck lymph nodes, histopathological was proven diagnosis of sarcoidosis. Due to neurological disturbances in form of headaches and vision problems patient was examined by an ophthalmologist, neurologist and endocrinologist. Hormonal analysis showed an increase of prolactin and that raised suspicion for neurosarcoidosis. In further diagnostic evaluation it was indicated MRI examination of the brain with focus on sellar region.
Contrast-enhanced MRI is the modality of choice for investigating suspected neurosarcoidosis. The versatility of MR recording and the amount of diagnostic informations obtained from MRI examination is huge. Comparison of MRI sequences obtained, facilitate interpretation of these findings. Obtained MRI information and available literature, correlating with other diagnostic modalities (ultrasound and CT) facilitate understanding of the specific pathology.
结节病是一种病因不明的多系统肉芽肿性疾病，其特征是受累组织中存在肉芽肿，临床表现多样，在诊断和治疗上存在两难困境。神经结节病的临床表现差异很大。诊断基于临床和放射学标准以及弥漫性非坏死性肉芽肿的组织学检查结果，同时细菌和真菌培养结果为阴性。MRI在检测脑实质内病变方面起着关键作用。
本文旨在介绍一名36岁男性患者的病例，该患者因发热、干咳伴白色痰液、颈部淋巴结肿大以及头痛和视力问题等神经功能障碍症状前来就医。
患者接受了肺部检查，结果显示存在结节病。进行了CT检查（德国埃尔朗根西门子Somatom Definition AS），证实存在纵隔和肺门淋巴结肿大。还对颈部进行了超声（US）检查，显示淋巴结明显肿大且形态改变。对多个颈部淋巴结进行活检后，组织病理学证实为结节病。由于患者存在头痛和视力问题等神经功能障碍，眼科医生、神经科医生和内分泌科医生对其进行了检查。激素分析显示催乳素升高，这增加了神经结节病的怀疑。在进一步的诊断评估中，建议对脑部进行MRI检查，重点关注蝶鞍区。
增强MRI是怀疑神经结节病时的首选检查方法。MR记录的多功能性以及从MRI检查中获得的诊断信息量巨大。对获得的MRI序列进行比较，有助于对这些结果进行解读。获得的MRI信息以及现有文献与其他诊断方法（超声和CT）相关联，有助于理解特定的病理情况。
