Disseminated intraparenchymal microgranulomas in the brainstem in central nervous system sarcoidosis.
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".
Nishie
Makoto
M
Department of Neuropathology, Institute of Brain Science, Hirosaki University School of Medicine, Hirosaki, Japan.
Mori
Fumiaki
F
Suzuki
Chieko
C
Ogawa
Masaya
M
Kurahashi
Kozo
K
Kaimori
Mitsuomi
M
Wakabayashi
Koichi
K
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