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The Role of MRI and Nerve Root Biopsy in the Diagnosis of Neurosarcoidosis

  • Fraser G.A. Moore (a1), Frederick Andermann (a1), John Richardson (a1), Donatella Tampieri (a1) and Robert Giaccone (a1)...

Abstract

Objectives:

Neurological involvement occurs in 5-15% of patients with sarcoidosis and isolated “neurosarcoidosis” occurs in less than 1% of all cases. Classical clinical presentations have been described, such as bilateral facial palsy, but often the disease presents insidiously with varied signs and symptoms. We present a patient who required biopsy of a lumbar nerve root for diagnosis of chronic, progressive neurosarcoidosis and review the literature with an emphasis on diagnosis.

Methods:

We have reviewed a patient who presented with signs and symptoms related to infiltration of her meninges and nerve roots by sarcoidosis. All pertinent history and physical information was taken from interviews with the patient and review of her chart. Laboratory, radiographic, and pathological investigations are presented.

Results and conclusions:

A high index of suspicion is required for the diagnosis of neurosarcoidosis. Gadolinium-enhanced MRI is useful but the findings are often nonspecific, and there should be a low threshold for biopsy whenever the diagnosis is considered.

RÉSUMÉ:

Le rôle de la RMN et de la biopsie nerveuse dans le diagnostic de la neurosarcoïse.

Objectifs:

Cinq à 15% des patients atteints de sarcoïse ont une atteinte neurologique et moins de un pour cent des patients ont une "neurosarcoïse". Des modes de présentation clinique classiques ont été décrits, telle la paralysie faciale bilatérale, mais souvent la maladie commence insidieusement par des signes et des symptômes variés. Nous présentons le cas d'un patient chez qui on a dûir recours à une biopsie d'une racine nerveuse lombaire pour poser le diagnostic de neurosarcoïse progressive chronique et nous revoyons la littérature en mettant l'emphase sur le diagnostic.

Méthodes:

Nous avons revu le cas d'un patient qui avait consulté pour des signes et des symptômes en relation avec une infiltration des méninges et de racines nerveuses par la sarcoïse. Toute l'information pertinente sur l'histoire et l'examen physique a été extraite d'entrevues avec la patiente et de son dossier médical. Les investigations biochimiques, radiologiques et anatomopathologiques sont présentées. Résultats et

Conclusions:

Le diagnostic de neurosarcoïse requiert un fort soupçon que cette maladie soit en cause. La RMN avec rehaussement par le gadolinium est utile, mais les constatations sont souvent non spécifiques. Quand ce diagnostic est considéré, on ne doit pas hésiter à procéder à une biopsie.

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References

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The Role of MRI and Nerve Root Biopsy in the Diagnosis of Neurosarcoidosis

  • Fraser G.A. Moore (a1), Frederick Andermann (a1), John Richardson (a1), Donatella Tampieri (a1) and Robert Giaccone (a1)...

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