Diagnostic and therapeutic pitfalls in neurosarcoidosis.
Neurosarcoidosis is a diagnostic challenge, especially in the absence of systemic involvement, even when cerebral biopsies show noncaseating granulomas. We report a patient with a pineal germinoma associated with a extensive peri- and intra- tumoural granulomatous reaction, who was first diagnosed as possible neurosarcoïdosis. A second patient was initially considered as suffering from Multiple Sclerosis. Brain biopsy showed typical granulomas and gallium scintigraphy revealed other locations of the disease. Unfortunately, he developed a severe, steroid-induced, epidural lipomatosis at the Th3-Th8 levels and died unexpectedly after surgical decompression. Granulomatous inflammation in a tissue obtained by biopsy from a midline lesion should be always considered for the differential diagnosis of germinoma. Corticosteroid-sparing immunosuppressant drugs should be used early in neurosarcoïdosis.
Visée
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Service de Neurologie, Université catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
Duprez
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Godfraind
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Sindic
C J M
CJ
D000328:Adult; D001921:Brain / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009422:Nervous System Diseases / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D012507:Sarcoidosis / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D013116:Spinal Cord / Q000473:pathology; D055815:Young Adult