Isolated Neurosarcoidosis Presenting as Chronic Progressive Pachymeningitis.

IF 0.9 Q4 CLINICAL NEUROLOGY Case Reports in Neurological Medicine Pub Date : 2023-01-01 DOI:10.1155/2023/2140740
Joshua Abata, Danielle Bazer, Nicholas Koroneos, Olga Syritsyna
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Abstract

Neurologic manifestations of sarcoidosis are rare, and even rarer still are cases of isolated neurosarcoidosis. The clinical presentation of isolated neurosarcoidosis can be highly variable, and diagnosis is particularly challenging, the gold standard being tissue biopsy. We describe a patient with a history of atypical parkinsonian syndrome and chronic right frontal lobe infarct who developed weakness, imbalance, and gait disequilibrium in 2008, with magnetic resonance imaging at that time showing leptomeningeal and nodular enhancements in the bilateral frontal and parietal lobes. The patient had an extensive negative workup in 2010 but ultimately did not receive a definitive diagnosis with a tissue biopsy until 2020. The patient also notably failed a 3-month course of steroids after his biopsy due to a lack of symptomatic improvement. This case highlights the clinical variability and diagnostic difficulties of isolated neurosarcoidosis. We also highlight that our patient did not have any symptomatic improvement on steroids, which do typically provide some relief for patients.

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孤立性神经结节病表现为慢性进行性厚性脑膜炎。
结节病的神经系统表现是罕见的,更罕见的是孤立的神经结节病的病例。孤立性神经结节病的临床表现可能是高度可变的,诊断特别具有挑战性,金标准是组织活检。我们描述了一位患有非典型帕金森综合征和慢性右额叶梗死史的患者,他在2008年出现虚弱、不平衡和步态不平衡,当时的磁共振成像显示双侧额叶和顶叶的脑膜薄和结节增强。患者在2010年进行了广泛的阴性检查,但最终直到2020年才通过组织活检得到明确的诊断。由于缺乏症状改善,患者活检后3个月的类固醇疗程也明显失败。本病例突出了孤立性神经结节病的临床变异性和诊断困难。我们还强调,我们的患者在类固醇治疗后没有任何症状改善,而类固醇治疗通常会给患者带来一些缓解。
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审稿时长
11 weeks
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