Presentation
most commonly, it presents as cranial neuropathy, but presentation ranges from encephalopathy, meningitis, hydrocephalus, and seizure to spinal cord dysfunction, peripheral neuropathy, and myopathy. 2, 3, 4, 10 Only rare cases of neurosarcoidosis presenting [ajnr.org]
Here, we present a case of isolated neurosarcoidosis that initially presented with hydrocephalus requiring ventriculoperitoneal shunt placement. [nnjournal.net]
Splenomegaly is present in about 17%. In approximately12%, osseous granulomas are present, most commonly in the phalanges of the fingers and toes. Involved phalanges appear swollen and deformed, often sausage-shaped. [dermaamin.com]
Case Report Mrs BM, a 52 year old lady presented in March 2008 to the ENT department at Royal Glamorgan Hospital, South Wales. [ispub.com]
About a third will have a nonspecific presentation with fever, fatigue, cachexia and lassitude and this presentation is more common in people of black or Indian origin. [patient.info]
Entire Body System
- Malaise
In older children, the disease is almost similar to the adult form with frequent pulmonary involvement and lymphadenopathy associated with fever, malaise and weight loss. [1] A 7-year-old girl presented with a history of redness and scaling almost all [ijdvl.com]
Fatigue, malaise, weakness, anorexia, weight loss, and low-grade fever are also common. Sarcoidosis can manifest as fever of unknown origin. [merckmanuals.com]
Patients may also suffer from fatigue, weight loss, weakness, malaise, fever, and ocular disease. Musculoskeletal involvement usually occurs in patients with generalized disease. [en.wikibooks.org]
Symptoms Constitutional upset Fever and night sweats, malaise, fatigue, weight loss. Heerfordt's syndrome (inflammation of submaxillary/parotid glands with uveitis and facial nerve palsy) may accompany constitutional presentation [ 6 ]. [patient.info]
- Falling
Insomnia is a sleep disorder that is characterized by difficulty falling and/or staying asleep. [memphislung.com]
[…] eastern niagara hospital erie county medical center john r oishei childlren's hospital kaiser permanente sacramento medical center kenmore mercy hospital mercy hospital of buffalo millard fillmore suburban hospital mount saint mary's hospital niagara falls [doctor.webmd.com]
There was a fall of ESR by 8 mm in first hour. [ijem.in]
Just when I thought my life might be falling back into place … my melon exploded! It’s difficult to explain, it’s harder to accept … Transient Global Amnesia. It seems I lost a day of my life. Not figuratively. Literally. [go2jo.com]
- Collapse
Head CT revealed collapsed lateral and third ventricles and a persistent dilatation of the fourth ventricle, which prompted placement of a ventriculoperitoneal shunt in the fourth ventricle. [nnjournal.net]
[…] see images of Grades I-V papilledema ) Diagnosis First, imaging studies of the patient's head (via magnetic resonance imaging or computed tomography) must be normal except for the signs of raised intracranial pressure (empty sella, flattened globes, collapsed [eyerounds.org]
Alignment deformities may result due to pathologic fractures with bone collapse rather than secondary to actual joint abnormalities. Extensive lytic lesions and subcortical tunneling. [en.wikibooks.org]
- Pallor
There may be cutaneous pallor caused by both vasoconstriction and alteration of the fraction of incident light, which results from increased water and mucopolysaccharide content in the dermis. [bobbybukamd.com]
- Dentist
Toxic: Beryllium hypersensitivity reaction (dentists, dental technicians, fluorescent lamp workers, factories, miners etc). Investigations: Bedside tests: ECG (arrhythmia, conduction block), oxygen saturations (pulmonary involvement). [ptpaces.wordpress.com]
Cardiovascular
- Tachycardia
Physical examination revealed stable and sustained ventricular tachycardia. However, ventricular tachycardia returned spontaneously to a normal sinus rhythm. [bmcpsychiatry.biomedcentral.com]
Clinically, he was anxious, had tachycardia, brisk reflexes, and tremors. Thyroid profile revealed T 3 2.58 ng/ml, T 4 21.41 μg/dl, and TSH 0.02 mIU/L. [ijem.in]
"Myocardial sarcoidosis, bouts of ventricular tachycardia, psychiatric manifestations and sudden death. A case report". Journal of the National Medical Association. 61 (4): 306–9. PMC 2611747. PMID 5796402. ^ Chapelon-Abric C (June 2012). [en.wikipedia.org]
- Palpitations
In the case described in the current report, the patient exhibited palpitations, dyspnea, chest pain, and fear of death. [bmcpsychiatry.biomedcentral.com]
[…] restrictive defect, impaired gas transfer), tissue biopsy (skin, lymph nodes, or via bronchoscopy or mediastinoscopy; non-caeseating granulomas which are negative for fungi and mycobacteria), slit lamp (posterior uveitis may be asymptomatic), if reporting palpitations [ptpaces.wordpress.com]
A 37-year-old male presented with weight loss, heat intolerance, excessive sweating, and palpitations of 6 months duration. Clinically, he was anxious, had tachycardia, brisk reflexes, and tremors. [ijem.in]
- Heart Disease
Heart disease This can (rarely) cause sudden death from arrhythmias or cause symptoms of heart failure in a young patient, due to cardiomyopathy [ 8 ]. [patient.info]
National Heart, Lung and Blood Institute. National Institutes of Health. 14 June 2013. Archived from the original on 27 February 2014. Retrieved 21 February 2014. ^ a b c Syed J, Myers R (January 2004). "Sarcoid heart disease". [en.wikipedia.org]
Psychiatrical
- Anxiety Disorder
Keywords Cardiac sarcoidosis Panic disorder Panic attacks Anxiety disorder Background Panic disorder is characterized by repeated panic attacks and anticipatory anxiety concerning these attacks [ 1 ]. [bmcpsychiatry.biomedcentral.com]
Urogenital
- Amenorrhea
[…] healthy until the early 90s when for no apparent reason I began to suffer periods of intermittent fatigue, difficulty in articulating myself, and a collection of seemingly unconnected and disparate symptoms like mild asthma, abdominal pain, weight loss, amenorrhea [bacteriality.com]
[…] temperature, mood, and prolactin (see the endocrine and exocrine section for details). [47] Endocrine and exocrine [ edit ] Prolactin is frequently increased in sarcoidosis, between 3 and 32% of cases have hyperprolactinemia [52] this frequently leads to amenorrhea [en.wikipedia.org]
Neurologic
- Seizure
People with epilepsy often have changes in their brain waves, even when they’re not having a seizure. Computerized tomography (CT) scan. [go2jo.com]
Neurological found in 5% Mononeuritis multiplex, Guillian-Barre, pure motor, pure sensory polyneuropathies, meningitis, seizure, arachnoiditis, myasthenia gravis-like symptoms, myelopathy. [slideshare.net]
[…] involvement, and spinal or nerve root enhancement. 4 – 9 Neurosarcoidosis also has a wide variety of clinical presentations; most commonly, it presents as cranial neuropathy, but presentation ranges from encephalopathy, meningitis, hydrocephalus, and seizure [ajnr.org]
Table 1: Signs and symptoms of neurosarcoidosis Sign or symptom Percent affected (%) References Cranial neuropathy 52-73 [ 3, 4 - 6 ] Aseptic meningitis 7-24 [ 3, 4 - 6 ] Peripheral neuropathy 6-24 [ 3 - 6 ] Cognitive impairment 2-27 [ 4, 5 ] Seizures [nnjournal.net]
After 2 hours of the procedure, she developed an episode of generalized tonic-clonic seizure. The next day (12 hours postprocedure), patient developed right hemiparesis with persistence of visual deficit and disoriented state. [annalsofian.org]
- Paresthesia
During this presentation, the patient experienced right leg paresthesias, slurred speech, right facial droop, and right upper and lower extremity weakness 2 hours after the first onset of symptoms. [ajnr.org]
Involvement of the central nervous system (CNS) occurs in 5-25% of sarcoidosis patients. [ 1 - 3 ] The most common symptoms associated with neurosarcoidosis are cranial nerve palsies, paresthesia, headache, weakness, ataxia, aseptic meningitis, peripheral [nnjournal.net]
It is relatively safe but nearly all patients experience the side effect of paresthesias, or numbness and tingling in the extremities. Patients also report an alteration in taste such that carbonated soft drinks taste metallic. [eyerounds.org]
[…] psychiatric symptoms in which sudden severe fear or discomfort increases and peaks within a few minutes, and four of 13 symptoms (palpitations, sweating, trembling, sensations of shortness of breath, feelings of choking, chest pain, nausea, dizziness, chills, paresthesia [bmcpsychiatry.biomedcentral.com]
- Tremor
Clinically, he was anxious, had tachycardia, brisk reflexes, and tremors. Thyroid profile revealed T 3 2.58 ng/ml, T 4 21.41 μg/dl, and TSH 0.02 mIU/L. [ijem.in]
- Tingling
It is relatively safe but nearly all patients experience the side effect of paresthesias, or numbness and tingling in the extremities. Patients also report an alteration in taste such that carbonated soft drinks taste metallic. [eyerounds.org]
Workup
This case highlights the importance of tissue diagnosis and the diagnostic workup for sarcoidosis in cases of cryptogenic hydrocephalus. [nnjournal.net]
She was diagnosed with idiopathic intracranial hypertension and referred to a neurologist for further workup and management. The neurologist performed a lumbar puncture which showed an elevated opening pressure of 50 cm H 2 O. [eyerounds.org]
Definitive diagnosis of neurosarcoidosis requires the exclusion of other causes of neuropathy and the identification of noncaseating sarcoid granulomas by histologic analysis of nerve and muscle biopsy specimens (see Workup). [emedicine.medscape.com]
"Sarcoidosis Workup". Medscape Reference. WebMD. Archived from the original on 1 March 2014. Retrieved 19 February 2014. ^ Allmendinger A, Perone R (2009). "Case of the Month". Diagnostic Imaging. 31 (9): 10. ^ Joanne Mambretti (2004). [en.wikipedia.org]
Foreign bodies in granulomatous cutaneous lesions and sarcoidosis are not mutually exclusive and, therefore, a workup to exclude systemic sarcoidosis should be undertaken [ 20, 25, 26, 27, 28, 29, 30, 31, 32 ]. [em-consulte.com]
Other Pathologies
- Granulomatous Tissue
Patient was subjected to FNAC thyroid which revealed ill-formed elements of granulomatous tissue. Patient refused to undergo the biopsy of the thyroid gland. [ijem.in]
Granulomatous production of parathyroid-hormone related protein (PTH-rP) may also play a role in abnormal calcium metabolism, 4 where tissue necrosis factor-alpha (TNF-α) and interleukin-6, produced by macrophages, increase PTH-rP gene expression. 4 PTH-rP [academic.oup.com]
Treatment
[…] in the 4-mg treatment group showed a significant increase compared with placebo ( P =.012). [clinicalpainadvisor.com]
At this time, there is no consistently effective treatment for necrobiosis lipoidica. Treatment options include corticosteroids, fibrinolytics, antiplatelet agents, and surgical treatments (i.e. excision and grafting). [bobbybukamd.com]
A variety of treatments for IIH have been proposed and there is much anecdotal evidence for these treatments. [eyerounds.org]
[…] as a treatment for cases with liver involvement. [113] Thalidomide has also been tried successfully as a treatment for treatment-resistant lupus pernio in a clinical trial, which may stem from its anti-TNF activity, although it failed to exhibit any [en.wikipedia.org]
The response to treatment often takes at least four weeks, with maximum treatment responses being observed at 12 weeks [ 142 ]. Relapse after discontinuation of treatment is common [ 141 ]. [em-consulte.com]
Prognosis
Seite 117 - Pulmonary sarcoidosis: role of CT in the evaluation of disease activity and functional impairment and in prognosis assessment. Radiology 191 (3): 675-680 141. [books.google.de]
May portend prognosis. Classified as: Specific (lesions contain granulomas) Non-specific (lesions are reactive processes and do not contain granulomas). 18. [slideshare.net]
They may be interpreted as a defense reaction against a tumor’s antigens, and may have a more favorable prognosis than classical malignant nodes. [omicsonline.org]
Early sarcoid arthritis is often self-limited, lasting for days to months, and the prognosis is excellent. [rheumaknowledgy.com]
Prognosis The prognosis of patients with sarcoidosis mainly depends on the extent and severity of the systemic involvement [ 15, 17, 18, 20 ]. [em-consulte.com]
Etiology
A discussion of the etiology, diagnosis, systemic and ocular manifestations, and treatment of sarcoidosis is presented. Format: video Series: Moran Eye Center Grand Rounds Identifier: Moran_CORE_21552 Copyright statement: Copyright 2016. [morancore.utah.edu]
Etiology: Although exposure to an infectious organism or some other environmental agent has long been hypothesized to be etiologically relevant to the disease, none has been conclusively implicated. [rheumaknowledgy.com]
Etiology and Clinical Diagnosis The etiologies of microscopic hematuria are numerous and range from clinically insignificant causes to potentially life-threatening neoplastic lesions 5 ( Table 1 2, 3, 7 – 9 ). [aafp.org]
Etiology Despite multiple investigations, the cause of sarcoidosis remains unknown. Currently, the most likely etiology is an infectious or noninfectious environmental agent that triggers an inflammatory response in a genetically susceptible host. [what-when-how.com]
Keywords Sarcoidosis; Schwannoma; Tumor; Benign Introduction Sarcoidosis is a multisystemic granulomatous disorder characterized by non caseating granulomas, of undetermined etiology, with bilateral mediastinal lymphadenopathy, pulmonary infiltration, [omicsonline.org]
Epidemiology
Gastroenterology, 127, S5-S16. [ 2 ] El-Serag, H.B. (2002) Hepatocellular carcinoma: An epidemiologic view. [scirp.org]
Epidemiology ► Exact prevalence (estimated at 10 to 20 per 100,000 population). ► Annual incidence of sarcoidosis are not known with certainty ► Incidence peaks in winter and early spring. Women greater incidence. [slideshare.net]
Epidemiology [ edit ] The prevalence of sarcoid is estimated to be 10 to 20 per 100,000 people. [en.wikibooks.org]
James DG, Hosoda Y: Epidemiology. In: James DG, ed. Sarcoidosis and other granulomatous disorders. New York, Marcel Dekker; 1994 :729–43 2. Stern BJ: Neurological complications of sarcoidosis. Curr Opin Neurol; 2004:17:311-6 3. [ispub.com]
"The epidemiology of sarcoidosis in Rochester, Minnesota: a population-based study of incidence and survival" (PDF). American Journal of Epidemiology. 123 (5): 840–5. doi : 10.1093/oxfordjournals.aje.a114313. [en.wikipedia.org]
Pathophysiology
Posterior reversible encephalopathy syndrome, part 2: Controversies surrounding pathophysiology of vasogenic edema. Am J Neuroradiol 2008;29:1043-9. [ PUBMED ] [ FULLTEXT ] 7. Saigal G, Bhatia R, Bhatia S, Wakhloo AK. [annalsofian.org]
ARA 290 relieves pathophysiological pain by targeting TRPV1 channel: Integration between immune system and nociception. Peptides. 2016;76:73-79. doi: 10.1016/j.peptides.2016.01.003 Heij L, Niesters M, Swartjes M, et al. [clinicalpainadvisor.com]
Pathophysiology [ edit ] The diagnosis of sarcoid is based on compatible clinical and radiographic findings, supportive laboratory data (elevated ACE levels, anergy, elevated serum gamma globulins, positive Kveim test), and evidence of noncaseating granulomas [en.wikibooks.org]
Pathophysiology and Immunopathogenesis The granuloma is the pathologic hallmark of sarcoidosis. A distinct feature of sarcoidosis is the local accumulation of inflammatory cells. [what-when-how.com]
Pathophysiology In IIH, there is no structural obstruction to the circulation of CSF. [eyerounds.org]
Prevention
Reducing Risk & Slowing Down the Disease Sarcoidosis can’t currently be cured, but it can be managed to prevent other problems, such as heart failure, from developing over time. [heart.templehealth.org]
Major goal : prevent fibrosis. Steroids first line : Help prevent fibrosis. Scarring cutaneous lesions Hypercalcemia Severe lung disease Liver disease Cardiac inflammation Posterior uveitis Neurosarcoidosis Severe sarcoidosis of other organs 46. [slideshare.net]
Prevention Although sarcoidosis cannot be prevented, some preventative measures may reduce complications. For example: Influenza vaccination. Osteoporosis prophylaxis (steroid usage). [patient.info]
Although primary prevention studies suggest that cholecalciferol is not entirely effective in preventing glucocorticoid-induced bone loss, 16 it is well tolerated by patients, and can be used once hypercalcaemia has been excluded. [academic.oup.com]
Prevention Prevention Because the cause of transient global amnesia is unknown and the rate of recurrence is low, no standard approaches for preventing the condition exist. [go2jo.com]