title: Neurosarcoidosis presenting with simple partial seizures and solitary enhancing mass: case reports and review of the literature.
abstract: A 37-year old woman, who had presented 5 years earlier with suspected simple partial seizures, returned with seizures increasing in frequency and intensity, confirmed by video/electroencephalography (VEEG) monitoring with left frontotemporal onset. A low-grade tumor was suspected, given a magnetic resonance imaging (MRI) study demonstrating enlargement of the left amygdala, anterior hippocampus, and adjacent mesial temporal neocortex, with modest gadolinium enhancement, and a positron emission tomography (PET) scan showing increased metabolism within that region. Surgical resection of the left mesial temporal lobe was performed and pathology revealed pathogen-free granulomas. She was given a diagnosis of sarcoidosis (following chest computed tomography that showed hilar adenopathy). She was treated with oral steroids for neurosarcoidosis with no further epileptic seizures in 19 months of follow-up. The second case was a young man, with known pulmonary sarcoidosis, who developed simple partial seizures and, later, complex partial seizures, with MRI revealing a left insular mass. Stereotactic biopsy again demonstrated pathogen-free granulomas. He has also done well in 4 years of follow-up. Review of the literature suggests that seizures associated with sarcoidosis do not invariably imply a poor prognosis. Certain features-multifocal parenchymal involvement, hydrocephalus, and chronic meningitis-were associated with poor outcome. In contrast, cases with isolated mass lesions often fared well.
authors.affiliation: University Hospitals of Cleveland, USA.
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Sponsler
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: Werz
authors.forename: Robert
authors.initials: R
authors.lastname: Maciunas
authors.forename: Mark
authors.initials: M
authors.lastname: Cohen
mesh_terms: D000328:Adult; D000818:Animals; D001927:Brain Diseases / Q000150:complications* / Q000628:therapy; D001931:Brain Mapping; D004569:Electroencephalography / Q000379:methods; D004828:Epilepsies, Partial / Q000209:etiology* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D049268:Positron-Emission Tomography / Q000379:methods; D012507:Sarcoidosis / Q000150:complications* / Q000628:therapy; D013256:Steroids / Q000627:therapeutic use; D014741:Video Recording / Q000379:methods
chemical_list: D013256:Steroids