By presenting this case, which to our knowledge is the first to report neurosarcoidosis presenting as hypothermia, our aim is to use it as a teaching moment and for further discussion on clinical presentations and management of such patients. [ncbi.nlm.nih.gov]

• Weakness

  People may have weakness in their arms and legs, and difficulty walking or controlling their urine or bowels. [mountsinai.org]

• Pain

  Yes I'm using it now and does help with my pain. I think it helps better for pain than the hydromorphone Yes I have isolated cardiac sarc (nowhere else) for Reply cont'd. [inspire.com]

  Our case demonstrates the importance of considering isolated neurosarcoidosis as a potential underlying etiology of painful ophthalmoplegia, even without systemic manifestation of the disease. [ncbi.nlm.nih.gov]

  Pain medication Inflammation of certain nerves can be painful and may be treated with pain medication. Pain medication may include narcotic drugs, which can also cause side effects, such as nausea, dry mouth, and sleepiness. [medicalnewstoday.com]

• Fatigue

  In neurosarcoidosis fatigue is a core symptom, but little is known about the relevance of fatigue on cognitive functions in this disease. Previous results in healthy subjects suggest that fatigue strongly affects cognitive control processes. [ncbi.nlm.nih.gov]

  Symptoms vary as any part of the nervous system can be affected, but they may include fatigue, excessive thirst, dizziness, headaches, loss of vision or sense of smell, speech impairment, loss of movement in any body part and nausea. [independent.ie]

  Symptoms of neurosarcoidosis vary widely and may include: Facial palsy Muscle weakness and wasting Numbness in various parts of the body Excessive thirst Fatigue Headache Seizures Lethargy Fever Memory loss Hallucinations Irritability/agitation Depression [diseases.emedtv.com]

  I spent most of the day asleep but no matter how much I slept it never relieved the fatigue. As my deterioration was slow and subtle those around me didn’t really notice it. [bacteriality.com]

• Difficulty Walking

  People may have weakness in their arms and legs, and difficulty walking or controlling their urine or bowels. [medlineplus.gov]

  People may have weakness in their arms and legs, and difficulty walking or controlling their urine or bowels. In some cases, the spinal cord is so severely affected that both legs are paralyzed. [nlm.nih.gov]

• Unconsciousness

  A 27-year-old male was admitted to our hospital with a history of unconsciousness and convulsion 1 month ago, which was suspected as a seizure. [ncbi.nlm.nih.gov]

• Vomiting

  The most frequent features were headaches, visual failure, ataxia and vomiting. [jnnp.bmj.com]

  Clinical Presentation Case 1 A 25 years male presented to Emergency Department with complaint of headache and altered consciousness for 3 days; he has nausea, vomiting without visual or behavioral problem. [omicsonline.org]

  The headaches continued and I began having daily nausea and vomiting. Also, I began developing double vision and my balance was terrible. It seriously affected my quality of life. [steadyhealth.com]

  […] inappropriate ADH secretion and the systemic findings of sarcoidosis was observed. 9 In a study investigating the relationship between sarcoidosis and pituitary mass, a patient diagnosed with pulmonary and ophthalmic sarcoidosis was presented with fatigue and vomiting [reumatologiaclinica.org]

• Nausea

  Symptoms vary as any part of the nervous system can be affected, but they may include fatigue, excessive thirst, dizziness, headaches, loss of vision or sense of smell, speech impairment, loss of movement in any body part and nausea. [independent.ie]

  Clinical Presentation Case 1 A 25 years male presented to Emergency Department with complaint of headache and altered consciousness for 3 days; he has nausea, vomiting without visual or behavioral problem. [omicsonline.org]

  Pain medication may include narcotic drugs, which can also cause side effects, such as nausea, dry mouth, and sleepiness. Narcotic pain medication can also be habit-forming and is usually only prescribed in the short term. [medicalnewstoday.com]

  The headaches continued and I began having daily nausea and vomiting. Also, I began developing double vision and my balance was terrible. It seriously affected my quality of life. [steadyhealth.com]

  One patient was taking methotrexate only briefly and was changed to azathioprine because of severe nausea. [jamanetwork.com]

• Dysphagia

  A 37-year-old man presented with dysphagia to solids and liquids, dysphonia, fatigue and 50 lb weight loss over 2 months. [ncbi.nlm.nih.gov]

  […] nerve involvement (particularly common) 5 facial nerve palsy endocrine features of hypothalamic/pituitary sarcoidosis 7 diabetes insipidus SIADH hyperprolactinemia hypothyroidism hypoadrenalism seizures variable weakness, paresthesias and dysarthria/dysphagia [radiopaedia.org]

  Other symptoms include hypoacusia, tinnitus, dizziness, trigeminal neuralgia, and dysphagia. Eventually the clinical picture will be that of Tolosa-Hunt or Garcin syndrome 5. [scielo.br]

  In addition, in the 1956 series collected by McGovern and Merritt 8 we were unable to identify the child tabulated by Weinberg et al as having “facial dysphagia.” TABLE 1. [pediatrics.aappublications.org]

• Hearing Impairment

  The optic and auditory nerves can also become involved, causing vision and hearing impairments. It can cause headache, seizures, memory loss, hallucinations, irritability, agitation, and changes in mood and behavior. [ninds.nih.gov]

  The optic and auditory nerves can also become involved, causing vision and hearing impairments. [houghton.moneomed.com]

  Some symptoms include facial muscle weakness, vision and hearing impairments, and changes in mood and behavior. Common symptoms reported by people with neurosarcoidosis Reports may be affected by other conditions and/or medication side effects. [patientslikeme.com]

• Tinnitus

  The second is a 36-year-old woman with rapid-onset horizontal diplopia, left mixed severe sensorineural hearing loss (SNHL) and tinnitus, diffuse leptomeningeal enhancement on MRI, and progressive palsy of the left CNs IV, VI, VII, IX, X and XI, with [ncbi.nlm.nih.gov]

  Patient and observation A 46-year-old lady with no significant medical history, was referred to our department after a 7 months history of gradually worsening bilateral hearing loss without tinnitus, vertigo or aural discharge. [panafrican-med-journal.com]

  Weakness of jaw muscles and muscle twitch Loss of sight or defects in visual perception Impaired taste and smell Sensorineural deafness (“brain deaf”), tinnitus and vertigo Involuntary tongue movements causing speech abnormalities and problems with swallowing [healthhype.com]

  […] may present with the following manifestations: impaired taste, blindness, blurry vision, double vision, visual field defects, pupillary abnormalities, dry or sore eyes, slurred speech, impaired swallowing, hoarseness, vertigo, sensorineural deafness, tinnitus [jneurology.com]

• Myalgia

  Guillain-Barré syndrome variant: presenting with myalgias and acute facial diplegia. Mil Med. 2008 ;173(5): 507 – 508. Google Scholar | Crossref | Medline | ISI 18. Elias, MK, Mateen, FJ, Weiler, CR. [journals.sagepub.com]

• Diplopia

  A 23-year-old African American man presented to our emergency department with diplopia, which was worsened on left horizontal gaze. On the day of admission, he had a witnessed seizure. [ncbi.nlm.nih.gov]

  CASE REPORT A 61-year-old man with a history of hypertensive cerebellar hemorrhage visited our hospital because of diplopia and fever. The diplopia was recognized when he gazed at the right side and disappeared with monocular vision. [surgicalneurologyint.com]

  Both diplopia and gait improved on corticosteroids but the symptoms recurred later that year. [dx.doi.org]

  Macarie 4 REZUMAT Introducere: Boala cronică de rinichi (BCR) poate More information Radiology of Multiple Sclerosis September 2000 Radiology of Multiple Sclerosis Patricia Bachiller, Harvard Medical School Year-IV Our Patient 40 y.o. woman with baseline diplopia [docplayer.net]

• Visual Impairment

  Symptoms of Neurosarcoidosis with involvement of parts of the brain and cranial nerves: Decreased hearing Disorientation and confusion Delirium Dizziness and vertigo Dementia or memory impairment Abnormal sensation of movement Visual impairment with double [epainassist.com]

  Subsequently, chloroquine at a dose of 150 mg b.i.d/day was added with regular monitoring of visual impairment. [neurologyindia.com]

  Sensory abnormalities 138/484 (29) Caucasian 461/739 (62) Hypaesthesia 39/174 (22) African 218/739 (29) Paraesthesia 69/334 (21) Other 27/739 (4) Neuropathic pain 25/216 (12) Unknown 33/739 (4) Gait abnormalities 128/466 (28) Presentation of disease Visual [bmcneurol.biomedcentral.com]

• Auditory Hallucination

  The first is a 39-year-old man with a history of progressively worsening hearing loss, followed by visual loss, delusions, agitation, ataxia, and musical auditory hallucinations, diffuse leptomeningeal enhancement on MRI with a normal serum angiotensin-converting [ncbi.nlm.nih.gov]

• Polyuria

  A 22-year-old man was referred to the endocrinology service with profound weight gain, polyuria and lethargy. [ncbi.nlm.nih.gov]

  Signs and symptoms of CNS involvement can include polyuria, polydipsia, obesity, impotence, amenorrhea, confusion/amnesia (short and long term memory), meningitis, and seizures (focal seizures). [encyclopedia.com]

  Due to hypothalamic-pituitary involvement, diabetes insipidus related symptoms like polydipsia and polyuria can occur. [reumatologiaclinica.org]

• Urinary Incontinence

  * Urinary incontinence. * Bowel incontinence. * Unable to dress himself. * Unable to write. * Unable to walk. * Depression * Short-term memory loss. * Anxiety. * Focal seizures. * Swelling legs. * Irregular diabetes (although he is monitored constantly [inspire.com]

  Case 2 25-year-old male presented to Emergency Department with decreased vision, recurrent bilateral lower limbs weakness, and urinary incontinence, On Neurological examination, patient has power 3/5, exaggerated reflexes in lower limbs with Up-going [omicsonline.org]

  There were no sensory deficits, and the patient did not complain of fecal or urinary incontinence. Head CT demonstrated bilateral frontal and right suboccipital approach ventricular catheters and a decompressed ventricular system. [nnjournal.net]

• Meningism

  Meningeal involvement may cause focal nodular enhancement that can simulate common cranial base tumors. [ncbi.nlm.nih.gov]

  Meningeal involvement can take the form of either an acute aseptic meningitis or a chronic meningitis. Meningeal mass lesions also can develop. [authorstream.com]

  While the cranial nerves are most frequently affected, neurosarcoidosis can involve other nervous system tissues including the meninges, brain parenchyma (especially the hypothalamic region), spinal cord, peripheral nerve, and muscle. [benthamscience.com]

• Seizure

  Common manifestations include leptomeningeal inflammation with seizures, headache, cranial nerve palsies, hydrocephalus, or focal neurological deficits with white matter lesions or mass lesions. [ncbi.nlm.nih.gov]

  Meningitis, encephalopathy, seizures and hydrocephalus are only a few of the nonspecific presentations neurosarcoid patients may exhibit. [path.upmc.edu]

• Headache

  In the remaining three cases headache was the only neurological symptom found in association with systemic features of sarcoidosis, and had the clinical features of tension-type headache. [ncbi.nlm.nih.gov]

  […] both of the following: a) headache has significantly worsened in parallel with worsening of the neurosarcoidosis b) headache has significantly improved in parallel with improvement in the neurosarcoidosis headache is accompanied by one or more cranial [ichd-3.org]

• Stroke

  Neurosarcoidosis and stroke. Stroke 1990 ; 21 : 152 –53 ↵ Brown MM, Thompson AJ, Wedzicha JA, et al. Sarcoidosis presenting with stroke. Stroke 1989 ; 20 : 400 –05 ↵ Ketonen L, Oksanen V, Kuuliala I. [ajnr.org]

  Stroke is relatively rare, and hemorrhage is much less common than ischemia due to vasculitis. [ncbi.nlm.nih.gov]

  Dr Stern receives research support from the National Institute of Neurological Disorders and Stroke and Remedy Pharmaceuticals. [journals.lww.com]

  Neurological Disorders and Stroke » [brainfacts.org]

• Peripheral Neuropathy

  The true incidence of peripheral neuropathy in sarcoidosis is unknown, as a significant number of asymptomatic patients with sarcoidosis have subclinical peripheral nerve involvement. Neuropathy occurs via 2 mechanisms. [emedicine.com]

  Keywords: Neurosarcoidosis, sarcoidosis, cranial neuropathy, meningitis, neuroendocrine dysfunction, seizures, peripheral neuropathy, myopathy Abstract: Neurosarcoidosis is an uncommon but potentially serious manifestation of sarcoidosis. [benthamscience.com]

  Among the peripheral nervous system manifestations, polyradiculitis and acute myopathy tend to respond well to steroids compared to the slowly progressive peripheral neuropathy and myopathy. [10] » References 1. John CJ, (Ed). [neurologyindia.com]

Laryngeal electromyography revealed high vagal injury, prompting workup on brain magnetic resonance imaging. On magnetic resonance imaging, 2 cases showed basilar leptomeningeal inflammation and 1 case showed a brainstem mass. [ncbi.nlm.nih.gov]

This case highlights the importance of tissue diagnosis and the diagnostic workup for sarcoidosis in cases of cryptogenic hydrocephalus. [nnjournal.net]

Therefore, a CT of the chest should be done on high clinical suspicion and moreover extensive workups like a MRI of the brain should be performed for patients who present with neurological symptoms as seen in our Case#01. [omicsonline.org]

• Mediastinal Mass

  In 2003, she received steroid therapy for one year for the mediastinal mass lesion with a good response. [ncbi.nlm.nih.gov]

We identified a total of 34 case reports on effective infliximab treatment of therapy-resistant neurosarcoidosis through PubMed search. Nineteen of the 34 cases reported the duration until treatment response. [ncbi.nlm.nih.gov]

Neurosarcoidosis is difficult to diagnose early and might be associated with a poor prognosis. [ncbi.nlm.nih.gov]

Prognosis The prognosis for patients with neurosarcoidosis varies. Approximately two-thirds of those with the condition will recover completely; the remainder will have a chronically progressing or on-and-off course of illness. [ninds.nih.gov]

Our case demonstrates the importance of considering isolated neurosarcoidosis as a potential underlying etiology of painful ophthalmoplegia, even without systemic manifestation of the disease. [ncbi.nlm.nih.gov]

[…] neu·ro·sar·coid·o·sis ( nū'rō-sar'koy-dō'sis ), A granulomatous disease of unknown etiology involving the central nervous system, usually with concomitant systemic involvement. neurosarcoidosis [-sär′koidō′sis] a granulomatous disease that may involve [medical-dictionary.thefreedictionary.com]

DISCUSSION: Fully comprehension of neurosarcoidosis is still a challenge due to its rarity and limited number of large published series, which renders the epidemiological study of this disease very difficult. [ncbi.nlm.nih.gov]

Morimoto T, Azuma A, Abe S, Usuki J, Kudoh S, Sugisaki K, Oritsu M, Nukiwa T: Epidemiology of sarcoidosis in Japan. Eur Respir J 2008;31:372-379. [karger.com]

Overview In this article, the authors present the current understanding of the epidemiology, diagnostic findings, proposed pathogenesis, relevant genetics, and therapeutic options for neurosarcoidosis. [medlink.com]

PURPOSE OF REVIEW: The aims of this article are to discuss the epidemiology, pathophysiology and clinical phenomenology of neurosarcoidosis, as well as current approaches to diagnosis and treatment. [ncbi.nlm.nih.gov]

The pathophysiology responsible for the unusual CT appearance and the differential diagnosis are discussed. Article History Published in print: 1986 [pubs.rsna.org]

One-third of those with neurosarcoidosis have or develop more than one neurologic manifestation NEUROSARCOID PATHOPHYSIOLOGY: NON-CASEATING GRANULOMAS Made up of EPITHELOID CELLS,GIANT CELLS,CENTRAL CD4 CELLS,PERIPHERAL CD8+ cells, B lymphocytes Increased [authorstream.com]

Pathophysiology Sarcoidosis is a disease of unknown cause that leads to the development of granulomas in various organs. While the lungs are typically involved, other organs may equally be affected. [wikidoc.org]

Neurosarcoidosis Pathophysiology The Immune System The body’s immune defense is a well coordinated system. Cells target and destroy foreign agents that enter the body. [healthhype.com]

It is important that neurosarcoidosis be in the differential diagnosis of mononeuritis multiplex when other causes cannot be found because early treatment could help prevent progression to other nerves. [ncbi.nlm.nih.gov]

Prevention of Neurosarcoidosis The only preventive measure that can be taken to avoid occurrence of neurosarcoidosis, is treating sarcoidosis at the right time. [epainassist.com]