Presentation
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]
Entire Body System
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Weakness
Herein we present a case of a previously healthy 55-year-old man who presented with leg weakness and was found to have diffuse involvement of his spinal cord by neurosarcoidosis. He was treated with steroids and recovered completely. [ncbi.nlm.nih.gov]
People may have weakness in their arms and legs, and difficulty walking or controlling their urine or bowels. [ufhealth.org]
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Pain
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]
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]
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]
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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]
We ask about general symptoms (anxious mood, depressed mood, fatigue, pain, and stress) regardless of condition. Last updated: January 31, 2019 [patientslikeme.com]
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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]
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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]
Gastrointestinal
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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]
[…] 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]
CASE REPORT A 23-year-old Japanese man was transferred to our hospital because of progressive consciousness disturbances with vomiting. [surgicalneurologyint.com]
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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]
One patient was taking methotrexate only briefly and was changed to azathioprine because of severe nausea. [jamanetwork.com]
Five months later, the patient presented to the outside hospital with a headache, nausea, vomiting, ataxia, dizziness, and blurred vision. [nnjournal.net]
Musculoskeletal
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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]
Eyes
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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]
Ears
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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]
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]
The optic and auditory nerves can also become involved, causing vision and hearing impairments. [houghton.moneomed.com]
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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]
Psychiatrical
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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]
Urogenital
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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]
Neurologic
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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]
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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]
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Stroke
Stroke is relatively rare, and hemorrhage is much less common than ischemia due to vasculitis. [ncbi.nlm.nih.gov]
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]
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Myelopathy
Various neurological complications of sarcoidosis commonly reported are cranial nerve palsies, aseptic meningitis, myelopathy and intracranial masses. [ncbi.nlm.nih.gov]
Extensive tract or gray matter-specific MRI changes are strongly associated with paraneoplastic myelopathies, particularly lung malignancies which may also show hilar lymphadenopathy. [5] Neurosarcoidosis and paraneoplastic myelopathies may mimic each [annalsofian.org]
Z....Mavija S. 2017 21 Neurosarcoidosis according to Zajicek and Scolding criteria: 15 probable and definite cases, their treatment and outcomes. ( 28716286 ) CaAsALo G....Santos E. 2017 22 Many faces of neurosarcoidosis: from chronic meningitis to myelopathy [malacards.org]
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Confusion
In the latter, it can be a source of considerable confusion, given the non-specific imaging appearance. [ncbi.nlm.nih.gov]
If the condition affects other parts of the brain or cranial nerves, symptoms may include: Headache Confusion, disorientation, and dementia Hearing or vision loss Bell’s palsy, which is characterized by weakness or drooping of the facial muscles Seizures [sarcoidosisnews.com]
If the condition is affecting the pituitary gland, symptoms may include: Changes in menstrual periods Fatigue Excessive thirst Excessive urination If the condition is affecting the brain or cranial nerves, symptoms may include: Confusion, disorientation [cedars-sinai.edu]
While hepatic encephalopathy may have accounted for the patient's confusion and seizure disorder, it is less likely that it could account for MRI findings in the cerebellum and leptomeninges, both of which were suggestive of neurosarcoidosis. [path.upmc.edu]
Workup
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]
X-Ray
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Mediastinal Mass
In 2003, she received steroid therapy for one year for the mediastinal mass lesion with a good response. [ncbi.nlm.nih.gov]
Treatment
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]
Prognosis
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]
Etiology
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]
Epidemiology
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]
Pathophysiology
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]
Prevention
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]