title: Neurosarcoidosis: guidance for the general neurologist.
abstract: Neurosarcoidosis (NS) more commonly occurs in the setting of systemic disease. The diagnosis is based on a clinical history suggestive of NS, presence of noncaseating granulomas, and supportive evidence of sarcoid pathology, laboratory, and imaging studies. NS could involve any part of the nervous system and often demands high doses of steroids for symptom control. It presents low response to isolated steroids administration and frequently requires immunosuppressive agents. In NS, lymphocytes are polarized toward an excessive Th1 response, leading to overproduction of TNF-alpha and INF-gama, as well as lL-2 and IL-15. Infliximab, a chimeric monoclonal antibody that neutralizes the biological activity of TNF-alpha, is a new option in the NS treatment. We revised pathophysiology, clinical manifestations, diagnostic work up, and treatment of NS as guidance for the general neurologist.
authors.affiliation: Division of General Neurology, Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, Brazil. liviaadutra@hotmail.com
authors.forename: Lívia Almeida
authors.initials: LA
authors.lastname: Dutra
authors.forename: Pedro
authors.initials: P
authors.lastname: Braga-Neto
authors.forename: Ricardo Araújo
authors.initials: RA
authors.lastname: Oliveira
authors.forename: José Luiz
authors.initials: JL
authors.lastname: Pedroso
authors.forename: Agessandro
authors.initials: A
authors.lastname: Abrahão
authors.forename: Orlando Graziani Povoas
authors.initials: OG
authors.lastname: Barsottini
mesh_terms: D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001927:Brain Diseases / Q000175:diagnosis* / Q000188:drug therapy*; D002493:Central Nervous System Diseases / Q000175:diagnosis* / Q000188:drug therapy*; D003937:Diagnosis, Differential; D006801:Humans; D008279:Magnetic Resonance Imaging; D012507:Sarcoidosis / Q000175:diagnosis* / Q000188:drug therapy*
chemical_list: D000893:Anti-Inflammatory Agents