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Brainstem Infarction and Panuveitis due to Sarcoidosis Successfully Treated with Steroid Pulse Therapy.

Yoshida-Hata N, Yashiro S, Arai N, Takeuchi S - Case Rep Med (2012)

Bottom Line: He was treated with steroid pulse therapy and his neurological and ocular symptoms immediately improved.Only seven similar cases of intracranical sarcoidosis have been reported, but none had been treated with steroid pulse therapy.We recommend that steroid pulse therapy be considered to treat patients with sarcoidosis with signs of lesions in the central nervous system.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, National Center for Global Health and Medicine, Tokyo 162-8655, Japan.

ABSTRACT
A 36-year-old man visited our hospital because of blurred vision and redness of the conjunctiva. Slit-lamp examination showed panuveitis. Two days later, he suddenly experienced dizziness, speech disturbance, paralysis of his right extremities, and gait disturbances. Neurological examinations suggested that his symptoms were caused by a left lateral medullary lesion. He also had erythema mainly on his trunk. Magnetic resonance imaging (MRI) of his brain demonstrated a small infarct on the left side of the medulla oblongata. Clinical presentation and MRI findings were consistent with the diagnosis of a Wallenberg's syndrome. He also had bilateral hilar lymphadenopathy. A skin biopsy showed granulomatous nodular dermatitis compatible with sarcoidosis. He was treated with steroid pulse therapy and his neurological and ocular symptoms immediately improved. Only seven similar cases of intracranical sarcoidosis have been reported, but none had been treated with steroid pulse therapy. We recommend that steroid pulse therapy be considered to treat patients with sarcoidosis with signs of lesions in the central nervous system.

No MeSH data available.


Related in: MedlinePlus

Histopathological section of skin biopsy. Nonnecrotizing granuloma with several multinucleated giant cells and epitheliod histiocytes can be seen. Hematoxylin-eosin ×250.
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fig3: Histopathological section of skin biopsy. Nonnecrotizing granuloma with several multinucleated giant cells and epitheliod histiocytes can be seen. Hematoxylin-eosin ×250.

Mentions: Two days after his first visit, he reported dizziness, speech disturbance, clumsiness of his right extremities, and gait disturbances. Neurological examinations showed left ptosis and miosis, hoarseness, dysphagia, right mild hemiparesis, left ataxia of his extremities, and truncal ataxia. He also had hypalgesia/hypotemperature on his right side. These findings suggested a left Wallenberg syndrome. Brain magnetic resonance imaging (MRI) showed an infarct on the left side of the medulla oblongata (Figure 2). Leptomeningeal enhancement was not observed on MRI. Studies of the cerebrospinal fluid showed normal glycorrhachia (74 mg/dL), mild lymphocyte elevation, and elevated protein at 69 mg/dL. These findings suggested inflammatory processes in the central nervous systems. Dermal examination/skin biopsy revealed granulomatous nodular dermatitis (Figure 3). 18F-FDG in the acute stage showed an upregulation of both hillar lymphadenitis in the mediastinum and ocular regions.


Brainstem Infarction and Panuveitis due to Sarcoidosis Successfully Treated with Steroid Pulse Therapy.

Yoshida-Hata N, Yashiro S, Arai N, Takeuchi S - Case Rep Med (2012)

Histopathological section of skin biopsy. Nonnecrotizing granuloma with several multinucleated giant cells and epitheliod histiocytes can be seen. Hematoxylin-eosin ×250.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3295379&req=5

fig3: Histopathological section of skin biopsy. Nonnecrotizing granuloma with several multinucleated giant cells and epitheliod histiocytes can be seen. Hematoxylin-eosin ×250.
Mentions: Two days after his first visit, he reported dizziness, speech disturbance, clumsiness of his right extremities, and gait disturbances. Neurological examinations showed left ptosis and miosis, hoarseness, dysphagia, right mild hemiparesis, left ataxia of his extremities, and truncal ataxia. He also had hypalgesia/hypotemperature on his right side. These findings suggested a left Wallenberg syndrome. Brain magnetic resonance imaging (MRI) showed an infarct on the left side of the medulla oblongata (Figure 2). Leptomeningeal enhancement was not observed on MRI. Studies of the cerebrospinal fluid showed normal glycorrhachia (74 mg/dL), mild lymphocyte elevation, and elevated protein at 69 mg/dL. These findings suggested inflammatory processes in the central nervous systems. Dermal examination/skin biopsy revealed granulomatous nodular dermatitis (Figure 3). 18F-FDG in the acute stage showed an upregulation of both hillar lymphadenitis in the mediastinum and ocular regions.

Bottom Line: He was treated with steroid pulse therapy and his neurological and ocular symptoms immediately improved.Only seven similar cases of intracranical sarcoidosis have been reported, but none had been treated with steroid pulse therapy.We recommend that steroid pulse therapy be considered to treat patients with sarcoidosis with signs of lesions in the central nervous system.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, National Center for Global Health and Medicine, Tokyo 162-8655, Japan.

ABSTRACT
A 36-year-old man visited our hospital because of blurred vision and redness of the conjunctiva. Slit-lamp examination showed panuveitis. Two days later, he suddenly experienced dizziness, speech disturbance, paralysis of his right extremities, and gait disturbances. Neurological examinations suggested that his symptoms were caused by a left lateral medullary lesion. He also had erythema mainly on his trunk. Magnetic resonance imaging (MRI) of his brain demonstrated a small infarct on the left side of the medulla oblongata. Clinical presentation and MRI findings were consistent with the diagnosis of a Wallenberg's syndrome. He also had bilateral hilar lymphadenopathy. A skin biopsy showed granulomatous nodular dermatitis compatible with sarcoidosis. He was treated with steroid pulse therapy and his neurological and ocular symptoms immediately improved. Only seven similar cases of intracranical sarcoidosis have been reported, but none had been treated with steroid pulse therapy. We recommend that steroid pulse therapy be considered to treat patients with sarcoidosis with signs of lesions in the central nervous system.

No MeSH data available.


Related in: MedlinePlus