O'Brien G M, Baughman R P, Broderick J P, Arnold L, Lower E E
Department of Internal Medicine, University of Cincinnati Medical Center, OH.
Sarcoidosis. 1994 Mar;11(1):34-6.
We present two patients with known sarcoidosis who developed neurosarcoidosis manifested by paranoid psychosis and clinical diabetes insipidus with hypernatremia. Both had gadolinium enhanced magnetic resonance imaging which demonstrated leptomeningeal and hypothalamic enhancement. Both had elevated protein and a lymphocytosis in their cerebrospinal fluid, which improved after corticosteroid therapy. The patients improved clinically with this therapy as well. We suggest that new onset psychosis in a sarcoid patient, particularly with symptoms of hypothalamic/pituitary involvement, should be evaluated for neurosarcoidosis with an MRI and CSF examination. If the results are consistent with neurosarcoidosis, the patient should be treated promptly with corticosteroids.
我们报告了两名已知患有结节病的患者，他们出现了以偏执性精神病和伴有高钠血症的临床尿崩症为表现的神经结节病。两人均进行了钆增强磁共振成像，显示软脑膜和下丘脑强化。两人的脑脊液蛋白均升高且有淋巴细胞增多，在接受皮质类固醇治疗后有所改善。患者经此治疗后临床症状也有所改善。我们建议，结节病患者新发精神病，尤其是伴有下丘脑/垂体受累症状时，应通过磁共振成像和脑脊液检查评估是否患有神经结节病。如果结果与神经结节病相符，患者应立即接受皮质类固醇治疗。
