title: Disseminated intraparenchymal microgranulomas in the brainstem in central nervous system sarcoidosis.
abstract: We report a 70-year-old woman with sarcoidosis and multiple cranial nerve palsy. The patient suffered from dysarthria, dysphagia and weakness of the upper and lower extremities and died of sepsis. No abnormalities were noted in brain MRI. At autopsy, numerous epithelioid granulomas with Langhans giant cells were present in the bilateral lungs, including the hilar lymph nodes. The brain had a normal external appearance. Histologically, there were brainstem parenchymal lesions consisting of many microgranulomas, lymphocytic infiltration, activated microglias and astrocytosis. Perivascular lympocytic cuffing was also seen. Neither granulomas nor lymphocytic infiltration were seen in the leptomeninges. The present case was considered to be a peculiar type of neurosarcoidosis, that is, "sarcoid brainstem encephalitis".
authors.affiliation: Department of Neuropathology, Institute of Brain Science, Hirosaki University School of Medicine, Hirosaki, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Nishie
authors.forename: Fumiaki
authors.initials: F
authors.lastname: Mori
authors.forename: Chieko
authors.initials: C
authors.lastname: Suzuki
authors.forename: Masaya
authors.initials: M
authors.lastname: Ogawa
authors.forename: Kozo
authors.initials: K
authors.lastname: Kurahashi
authors.forename: Mitsuomi
authors.initials: M
authors.lastname: Kaimori
authors.forename: Koichi
authors.initials: K
authors.lastname: Wakabayashi
mesh_terms: D000368:Aged; D001933:Brain Stem / Q000473:pathology*; D003389:Cranial Nerve Diseases / Q000209:etiology / Q000473:pathology; D021902:Enterobacter aerogenes; D004756:Enterobacteriaceae Infections / Q000209:etiology; D017809:Fatal Outcome; D005260:Female; D006099:Granuloma / Q000209:etiology / Q000473:pathology*; D006801:Humans; D008168:Lung / Q000473:pathology; D008198:Lymph Nodes / Q000473:pathology; D008279:Magnetic Resonance Imaging; D012507:Sarcoidosis / Q000150:complications* / Q000473:pathology / Q000503:physiopathology; D012772:Shock, Septic / Q000209:etiology