Taşdemiroglu E, Nazek M, Zuccarello M
Veterans Affairs Medical Center, Neurosurgical Service, Cincinnati, Ohio, USA.
Neurosurg Rev. 1997;20(4):269-73. doi: 10.1007/BF01105898.
A 31-year-old black male with sarcoidosis en-plaque of the dura mater, which is a rare morphological variant of neurosarcoidosis (NS), presented at our clinic. Magnetic resonance imaging (MRI) of the head with gadolinium showed non-specific enhancement of both tentorial leaves extending to the floor of right middle cranial fossa and cavernous sinus. The laboratory results were normal except for slightly increased serum angiotensin converting enzyme (SACE) (68 U/ml n = 4-56 U/ml) and cerebrospinal fluid (CSF) IgG index (0.57, n = 0.46). Biopsy of the intracranial dural lesion was consistent with sarcoidosis. Oral steroid therapy (Methylprednisolone 4 mg QID) was started and the patient became asymptomatic. However, MRI of the brain with gadolinium 2 months after biopsy showed progression and extension of the enhanced dural lesion. His SACE level was unchanged. We concluded that progression of the enhanced lesion seen in MRI could be recently formed scar tissue, new lesion or both. MRI findings should always be correlated with clinical findings for evaluation of NS during follow-up.
一名31岁的黑人男性因硬脑膜结节病斑块前来我院就诊，硬脑膜结节病斑块是神经结节病（NS）的一种罕见形态学变异。头颅钆增强磁共振成像（MRI）显示小脑幕叶双侧有非特异性强化，延伸至右侧中颅窝底和海绵窦。实验室检查结果除血清血管紧张素转换酶（SACE）略有升高（68 U/ml，正常范围4 - 56 U/ml）和脑脊液（CSF）IgG指数升高（0.57，正常范围0.46）外均正常。颅内硬脑膜病变活检符合结节病。开始口服类固醇治疗（甲泼尼龙4 mg，每日4次），患者症状消失。然而，活检后2个月的头颅钆增强MRI显示强化的硬脑膜病变进展并扩大。他的SACE水平未变。我们得出结论，MRI上所见强化病变的进展可能是新形成的瘢痕组织、新病变或两者皆有。在随访期间评估NS时，MRI结果应始终与临床结果相关联。
