Hayashi T, Onodera J, Nagata T, Mochizuki H, Itoyama Y
Department of Neurology, Tohoku University School of Medicine.
Rinsho Shinkeigaku. 1995 Sep;35(9):1008-11.
Here we report a 36-year-old male with sarcoid meningoencephalitis who initially presented with hallucination, nominal aphasia and disturbance of consciousness. After the onset, his symptoms fluctuated. He had no meningeal signs, and his cranial nerves were normal except for bilateral papapilledema. Muscle power and tone was normal, and there was no gait disturbance. Deep tendon reflexes were slightly exaggerated in lower extremities, but no pathological reflexes were noted. There was no impairment in extrapyramidal system, cerebellar system and sensory system. The cerebrospinal fluid revealed increased opening pressure, mild lymphocytic pleocytosis, slightly decreased glucose, increased protein to 87mg/dl and increased IgG index to 1.11. Cerebrospinal fluid culture was negative. Marked meningeal thickening and contrast enhancement was shown by CT and MRI. The meningeal biopsy demonstrated characteristic sarcoid nodules and confirmed the diagnosis of neurosarcoidosis. His manifestations were alleviated by oral administration of corticosteroid. Since neurosarcoidosis is a disorder treatable with corticosteroid, it is important to consider the possibility of this disorder in mind when a patient is presenting with psychiatric manifestations and chronic meningitis.
在此，我们报告一名36岁患有结节病性脑膜脑炎的男性患者，其最初表现为幻觉、命名性失语和意识障碍。起病后，他的症状有波动。他没有脑膜刺激征，除双侧视乳头水肿外，其颅神经正常。肌力和肌张力正常，无步态障碍。下肢腱反射略亢进，但未引出病理反射。锥体外系、小脑系统和感觉系统无损害。脑脊液显示初压升高、轻度淋巴细胞增多、葡萄糖略降低、蛋白升高至87mg/dl，IgG指数升高至1.11。脑脊液培养阴性。CT和MRI显示明显的脑膜增厚和强化。脑膜活检显示特征性的结节病结节，确诊为神经结节病。口服皮质类固醇后其症状得到缓解。由于神经结节病是一种可用皮质类固醇治疗的疾病，因此当患者出现精神症状和慢性脑膜炎时，考虑这种疾病的可能性很重要。
