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A case of sarcoidosis of the central nervous system and orbita.

Mercan M, Akyol A, Karaman Y, Bolay H - Case Rep Med (2015)

Bottom Line: After laboratory tests and imaging studies, the patient was diagnosed with probable neurosarcoidosis using the Zajicek criteria and treated with prednisone (1 mg/kg/day).Patients with orbital symptoms may receive a late diagnosis and insufficient central nervous system treatment.Therefore, early diagnosis and treatment are very important.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, Gazi University Faculty of Medicine, 06410 Ankara, Turkey.

ABSTRACT
Sarcoidosis is a multisystemic disease characterized by granulomatous inflammation. Lung or lymph node involvement is common. We present a rare case of sarcoidosis that began with orbital involvement, and a month later, due to insufficient treatment, it involved the central nervous system. A 49-year-old female patient began suffering from swelling in her right eye, redness, ptosis, and limited eye movements two months ago. Gadolinium-enhanced orbital magnetic resonance imaging showed thickening of the lacrimal gland and the right medial rectus muscle. After three weeks of local antibiotic and steroid treatments, her symptoms were resolved. One month ago, the patient reported sudden weakness in her right arm and leg. After laboratory tests and imaging studies, the patient was diagnosed with probable neurosarcoidosis using the Zajicek criteria and treated with prednisone (1 mg/kg/day). Although sarcoidosis frequently presents with lung and lymph node involvement, it is rarely accompanied by orbital involvement. Patients with orbital symptoms may receive a late diagnosis and insufficient central nervous system treatment. Involvement of the central nervous system in sarcoidosis leads to high morbidity and mortality rates. Therefore, early diagnosis and treatment are very important.

No MeSH data available.


Related in: MedlinePlus

Thickening of the medial rectus muscle (short arrow; right diameter 9.5 mm; left diameter 5.8 mm) with gadolinium enhancement of the right lacrimal gland (long arrow) and periorbital fatty tissue in the axial fat-suppressed postcontrast T1-weighted sequences (a). The lacrimal gland and the medial rectus muscle appear normal in the axial fat-suppressed postcontrast T1-weighted sequences (b). Pial-gyral nodular gadolinium-enhanced lesions (short arrow) are detected in the bilateral occipital and parietal areas in the sagittal postcontrast T1-weighted sequences (c). Pial gadolinium enhancement (long arrow) and diffuse enhancement of the 9th and 10th cranial nerves (short arrow) are observed in both cerebellar hemispheres in the axial postcontrast T1-weighted sequences (d). Pial-gyral nodular gadolinium enhancement was also observed to be adjacent to the right optic foramen and the bilateral occipital area in axial postcontrast T1-weighted sequences (arrowhead) (e). In axial T2-weighted sequences, hyperintense multiple nodular lesions were detected in the bilateral periventricular white matter (f).
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fig1: Thickening of the medial rectus muscle (short arrow; right diameter 9.5 mm; left diameter 5.8 mm) with gadolinium enhancement of the right lacrimal gland (long arrow) and periorbital fatty tissue in the axial fat-suppressed postcontrast T1-weighted sequences (a). The lacrimal gland and the medial rectus muscle appear normal in the axial fat-suppressed postcontrast T1-weighted sequences (b). Pial-gyral nodular gadolinium-enhanced lesions (short arrow) are detected in the bilateral occipital and parietal areas in the sagittal postcontrast T1-weighted sequences (c). Pial gadolinium enhancement (long arrow) and diffuse enhancement of the 9th and 10th cranial nerves (short arrow) are observed in both cerebellar hemispheres in the axial postcontrast T1-weighted sequences (d). Pial-gyral nodular gadolinium enhancement was also observed to be adjacent to the right optic foramen and the bilateral occipital area in axial postcontrast T1-weighted sequences (arrowhead) (e). In axial T2-weighted sequences, hyperintense multiple nodular lesions were detected in the bilateral periventricular white matter (f).

Mentions: For years, a 49-year-old female suffered from sudden eruptions of erythematous that recovered without treatment. Two months ago, magnetic resonance imaging (MRI) was performed due to swelling, redness, ptosis, and restriction of movement in the patient's right eye. The MRI revealed thickening of the right lacrimal gland and the medial rectus muscle and the contrast agent was retained in the lacrimal gland (Figure 1(a)). The patient's symptoms receded after three weeks of treatment with local steroids and antibiotics. One month ago, the patient suddenly developed muscle weakness in the right arm and leg. She improved after four days of treatment with 1,000 mg/day of methylprednisolone.


A case of sarcoidosis of the central nervous system and orbita.

Mercan M, Akyol A, Karaman Y, Bolay H - Case Rep Med (2015)

Thickening of the medial rectus muscle (short arrow; right diameter 9.5 mm; left diameter 5.8 mm) with gadolinium enhancement of the right lacrimal gland (long arrow) and periorbital fatty tissue in the axial fat-suppressed postcontrast T1-weighted sequences (a). The lacrimal gland and the medial rectus muscle appear normal in the axial fat-suppressed postcontrast T1-weighted sequences (b). Pial-gyral nodular gadolinium-enhanced lesions (short arrow) are detected in the bilateral occipital and parietal areas in the sagittal postcontrast T1-weighted sequences (c). Pial gadolinium enhancement (long arrow) and diffuse enhancement of the 9th and 10th cranial nerves (short arrow) are observed in both cerebellar hemispheres in the axial postcontrast T1-weighted sequences (d). Pial-gyral nodular gadolinium enhancement was also observed to be adjacent to the right optic foramen and the bilateral occipital area in axial postcontrast T1-weighted sequences (arrowhead) (e). In axial T2-weighted sequences, hyperintense multiple nodular lesions were detected in the bilateral periventricular white matter (f).
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4355551&req=5

fig1: Thickening of the medial rectus muscle (short arrow; right diameter 9.5 mm; left diameter 5.8 mm) with gadolinium enhancement of the right lacrimal gland (long arrow) and periorbital fatty tissue in the axial fat-suppressed postcontrast T1-weighted sequences (a). The lacrimal gland and the medial rectus muscle appear normal in the axial fat-suppressed postcontrast T1-weighted sequences (b). Pial-gyral nodular gadolinium-enhanced lesions (short arrow) are detected in the bilateral occipital and parietal areas in the sagittal postcontrast T1-weighted sequences (c). Pial gadolinium enhancement (long arrow) and diffuse enhancement of the 9th and 10th cranial nerves (short arrow) are observed in both cerebellar hemispheres in the axial postcontrast T1-weighted sequences (d). Pial-gyral nodular gadolinium enhancement was also observed to be adjacent to the right optic foramen and the bilateral occipital area in axial postcontrast T1-weighted sequences (arrowhead) (e). In axial T2-weighted sequences, hyperintense multiple nodular lesions were detected in the bilateral periventricular white matter (f).
Mentions: For years, a 49-year-old female suffered from sudden eruptions of erythematous that recovered without treatment. Two months ago, magnetic resonance imaging (MRI) was performed due to swelling, redness, ptosis, and restriction of movement in the patient's right eye. The MRI revealed thickening of the right lacrimal gland and the medial rectus muscle and the contrast agent was retained in the lacrimal gland (Figure 1(a)). The patient's symptoms receded after three weeks of treatment with local steroids and antibiotics. One month ago, the patient suddenly developed muscle weakness in the right arm and leg. She improved after four days of treatment with 1,000 mg/day of methylprednisolone.

Bottom Line: After laboratory tests and imaging studies, the patient was diagnosed with probable neurosarcoidosis using the Zajicek criteria and treated with prednisone (1 mg/kg/day).Patients with orbital symptoms may receive a late diagnosis and insufficient central nervous system treatment.Therefore, early diagnosis and treatment are very important.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, Gazi University Faculty of Medicine, 06410 Ankara, Turkey.

ABSTRACT
Sarcoidosis is a multisystemic disease characterized by granulomatous inflammation. Lung or lymph node involvement is common. We present a rare case of sarcoidosis that began with orbital involvement, and a month later, due to insufficient treatment, it involved the central nervous system. A 49-year-old female patient began suffering from swelling in her right eye, redness, ptosis, and limited eye movements two months ago. Gadolinium-enhanced orbital magnetic resonance imaging showed thickening of the lacrimal gland and the right medial rectus muscle. After three weeks of local antibiotic and steroid treatments, her symptoms were resolved. One month ago, the patient reported sudden weakness in her right arm and leg. After laboratory tests and imaging studies, the patient was diagnosed with probable neurosarcoidosis using the Zajicek criteria and treated with prednisone (1 mg/kg/day). Although sarcoidosis frequently presents with lung and lymph node involvement, it is rarely accompanied by orbital involvement. Patients with orbital symptoms may receive a late diagnosis and insufficient central nervous system treatment. Involvement of the central nervous system in sarcoidosis leads to high morbidity and mortality rates. Therefore, early diagnosis and treatment are very important.

No MeSH data available.


Related in: MedlinePlus