[Pseudotumor forms of neurosarcoidosis in children. Diagnostic difficulties and therapeutic management].
In systemic sarcoidosis, neurologic manifestations are possible and occurred in 5 p. 100 of cases. The diagnosis is easier when sarcoiddosis is known, but in half case neurologic symptoms are inaugural. In these cases, involvement of other sites (liver, lung, eyes or skin) by the disease is needed to confirm sarcoidosis. Main manifestations in neurosarcoidosis are cranial nerve palsy, diabetes insipidus or chronic aseptic meningitis, but sometimes sarcoidosis can present as an intracranial mass. The diagnosis of neurosarcoidosis may be difficult and could be confused with infection (such tuberculosis or mycosis), with inflammatory diseases (such multiple sclerosis) or with neoplasm, particularly in case of oedema. Brain biopsy may be necessary in isolated neurosarcoidosis if no peripheral histology evidence of noncaseating granulomas has been obtained. Treatment with steroids alone is the best choice for initial therapy but must be prolonged. It is difficult to predict accurately the response to steroids and relapse may be possible after a long time. Other immunosuppressive therapeutics or radiotherapy have been used in patient with refractory neurosarcoidosis. Sequential magnetic resonance imaging is the useful mean for the follow-up of neurosarcoidosis.
Service de Médecine Infantile A, Hôpital de Purpan, Toulouse.
Y
Y
Chaix
E
E
Grouteau
A
A
Sevely
S
S
Boetto
M B
MB
Delisle
J P
JP
Carrière
D000293:Adolescent; D001927:Brain Diseases / Q000175:diagnosis* / Q000628:therapy; D001932:Brain Neoplasms / Q000175:diagnosis; D003937:Diagnosis, Differential; D006801:Humans; D008297:Male; D012507:Sarcoidosis / Q000175:diagnosis* / Q000188:drug therapy