Caparros-lefebvre D, Wallaert B, Girard-Buttaz I, De Sèze J, Blond S, Ruchoux M M, Pruvo J P, Petit H
Service de Neurologie, CHU Lille.
Rev Neurol (Paris). 1996 Mar;152(3):196-201.
Central nervous system lesions resulting from sarcoidosis occur in 5% of cases, but supratentorial mass lesions are uncommon. We report 3 cases of intracranial pseudo-tumoral lesions, due to sarcoidosis: 1 woman and 2 men. Clinical features included left facial myoclonus, headache and vertigo, right hemiparesis and unique general seizure. Sarcoidosis was diagnosed upon conjonctival biopsy in the first case, infiltrative lesions of the lungs and mediastinal lymph nodes in the second case, and intracerebral lesion plus lymph nodes biopsies in the last case. In the first case, CT scan and MRI images showed diffuse subcortical high signal, suggesting pachymeningitis with vasogenic oedema. In the second case, GT scan and MRI revealed numerous small granuloma in the left rolandic area, and one in the striatum. In the third case, CT scan showed an enlargement of the left temporal horn, due to an enhanced left periventricular lesion. MRI with gadolinium showed that the lesion encircled the ventricle horn. In all cases, clinical and radiological improvement was obtained after corticoid therapy.
结节病导致的中枢神经系统病变在5%的病例中出现，但幕上占位性病变并不常见。我们报告3例因结节病引起的颅内假瘤样病变病例：1名女性和2名男性。临床特征包括左侧面部肌阵挛、头痛和眩晕、右侧偏瘫以及独特的全身性癫痫发作。第一例通过结膜活检诊断为结节病，第二例通过肺部和纵隔淋巴结的浸润性病变诊断，最后一例通过脑内病变加淋巴结活检诊断。第一例中，CT扫描和MRI图像显示弥漫性皮质下高信号，提示硬脑膜炎伴血管源性水肿。第二例中，CT扫描和MRI显示左侧中央前回区域有许多小肉芽肿，纹状体有一个。第三例中，CT扫描显示左侧颞角扩大，原因是左侧脑室周围病变增强。钆增强MRI显示病变环绕脑室角。所有病例在使用皮质类固醇治疗后临床和影像学均有改善。
