Neurosarcoidosis

Glucose >50% of the serum values Acute bacterial meningitis Tuberculosis meningitis Cryptococcal meningitis Listeria meningitis Neurosarcoidosis ... 

Gullapalli D, Phillips LH, II (2004). Neurosarcoidosis. Current Neurology and Neuroscience Reports 4 441-447 Hankey GJ (1991). Isolated angiitis/angiopathy of the central nervous system. Cerebrovascular Diseases 1 2-15 Harrison CN, Linch DC, Machin SJ (1998). Desirability and problems of early diagnosis of essential thrombocythemia. Lancet 351 846-847... 

Spencer TS, Campellone JV, Maldonado I et al. (2005). Clinical and magnetic resonance imaging manifestations of neurosarcoidosis. Seminars in Arthritis and Rheumatism 34 649-661... 

Zajicek JP (2000). Neurosarcoidosis. Current Opinions in Neurology 13 323-325 Zuber M, Khoubesserian P, Meder JF et al. (1993). A 34-year delayed and focal postirradiation intracranial vasculopathy. Cerebrovascular Diseases 3 181-182 Zuckerman D, Selim R, Hochberg E (2006). Intravascular lymphoma the oncologist s great imitator. Oncologist 11 496-502... 

Neurosarcoidosis has been reported in a patient with chronic hepatitis C who was treated with interferon beta. 

Miwa H, Furuya T, Tanaka S, Mizuno Y. Neurosarcoidosis associated with interferon therapy. Eur Neurol 2001 45(4) 288-9. 

Doty JD, Mazur JE, Judson MA. Treatment of corticosteroid-resistant neurosarcoidosis with a short-course cyclophosphamide regimen. Chest 2003 124 2023-2026. 

Stem BJ, Schonfeld SA, SeweU C, et al. The treatment of neurosarcoidosis with cyclosporine. Archives of Neurology 1992 49 1065-1072. 

Dubey N, Miletich RS, Wasay M, et al. Role of fluorodeoxyglucose positron emission tomography in the diagnosis of neurosarcoidosis. J Neurol Sci 2002 205(1) 77-81. 

Pettersen JA, Zochodne DW, Bell RB, et al. Refractory neurosarcoidosis responding to infliximab. Neruology 2002 59(10) 1660-1661. 

Clinically apparent involvement of the nervous system occurs in 5% to 15% of sarcoidosis patients (143,144). However as with other forms of sarcoidosis, asymptomatic neurologic disease is much more frequent (145,146). Approximately 15% of sarcoidosis deaths in the United States are attributable to neurosarcoidosis (147). In ACCESS, sarcoidosis was more common in women than men [28/468 (6.0%) versus 6/268 (2.2%), chi-square 7.28, p < 0.01) (2). There was no predilection on the basis of age or race. 

Neurosarcoidosis most frequently involves the cranial nerves (143,146). A peripheral seventh nerve palsy (Bell s Palsy) is the most common neurologic manifestation of sarcoidosis (29,146). It may be unilateral, bilateral, and frequently predates the diagnosis of sarcoidosis (146). Any other cranial nerve may be affected, and in many series the nerves supplying the extraocular muscles or optic nerves are not rarely involved (148-150). 

There are many other manifestations of neurosarcoidosis. Probably one of the most underappreciated of these is spinal sarcoidosis. Patients may present with transverse myelopathy, autonomic dysfunction, paresis, radicular syndrome, and cauda equina syndrome (146,159,160). Sarcoidosis may cause a peripheral neuropathy (143,150), Guillain-Barre syndrome (146,150,161,162), and seizures (150,162) the presence of seizures portends a poor prognosis (146). Granulomatous infiltration of the CNS from... 

Corticosteroids are the cornerstone of treatment of neurosarcoidosis (168,169). However the response to corticosterrads is inconsisteit and high doses are often required (150,151,168-170). Some have advocated a starting dose of 40 to 80 mg/day of prednisone equivalent (168). Relapses are common when the dose lowered to 20 to 25 mg/day of pednisrme equivalent (149). 

James DG, Sharma OP. Neurosarcoidosis. Proc R Soc Med 1967 60 1169-1170. Sharma OP, Sharma AM. Sarcoidosis of the nervous sytem. A clinical approach. Arch Intern Med 1991 151 1317 1321. 

Hoitsma E, Sharma OP. Neurosarcoidosis. Eur Respir J Monogr 2005 10 164-187. Huang CT, Heurich AE, Sutton AL, et al. Mortality in sarcoidosis. A changing pattern of the causes of death. Eur J Respir Dis 1981 62 231-238. 

Kumar N, Erohmam EM. Spinal neurosarcoidosis mimicking an idiopathic inflammatory demyelinating syndrome. Arch Neurol 2004 61 586-589. 

Oksanen V. Neurosarcoidosis clinical presentations and course in 50 patients. Acta Neurol Scand 1896 73 283 290. 

Plotkin GR, Patel BR. Neurosarcoidosis presenting as chronic lymphocytic meningitis. Pa Med 1986 89 36 7. 

Bullmann C, Faust M, Hoffmann A, et al. Five cases with central diabetes insipidus and hypogonadism as first presentation or neurosarcoidosis. Fur J Endocrinol 2000 142 365-372. 

Konrad D, Gartenmann M, Martin E, et al. Central diabetes insipidus as the first manifestation of neurosarcoidosis in a 10-year-old girl. Horm Res 2000 54 98-100. 

Sharma OP. Neurosarcoidosis A personal perspective based on the study of 37 patients. Chest 1997 112 220-228. 

Ferriby D, de Seze J, Stojkovic T, et al. Long-term follow-up of neurosarcoidosis. Neurology 2001 57 927-929. 

Agbogu BN, Stem BJ, Sewell C, et al. Therapeutic considerations in patients with refractory neurosarcoidosis. Arch Neurol 1995 52 875-879. 

Kang S, Suh JH. Radiation therapy for neurosarcoidosis report of three cases from a single institution. Radiat Oncol Investig 1999 7 309-312. 

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