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      Leptomeningeal Enhancement due to Neurosarcoidosis Mimicking Malignancy

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          Abstract

          The present report describes the case of a 56-year-old African American man experiencing progressive disequilibrium, lower extremity weakness, difficulty walking, and hearing loss. Brain magnetic resonance imaging showed leptomeningeal enhancement. Initial differential diagnosis was broad, including malignant, infectious, and inflammatory etiologies. The cerebrospinal fluid analyses demonstrated lymphocytic pleocytosis, hypoglycorrhachia, and hyperproteinorrachia but no other abnormalities. An extensive infectious disease workup was negative. Positron emission tomography revealed hypermetabolic lymph nodes in the right mediastinum and right hilum, correlating with findings on endobronchial ultrasonography. Subsequently, image-guided fine-needle aspiration of the right upper paratracheal lymph node was performed, and biopsy studies showed noncaseating granulomatous inflammation. Based on the clinical picture, the diagnosis of neurosarcoidosis was made, and high-dose steroids were started and resulted in significant improvement.

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          Most cited references 7

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          Imaging of neurosarcoidosis: common, uncommon, and rare

          Sarcoidosis is an idiopathic inflammatory disease that may affect any organ system and have protean manifestations. Neurosarcoidosis refers to involvement of the central nervous system and may occur in patients with known sarcoidosis, or be the initial manifestation of the disease. In the latter, it can be a source of considerable confusion, given the non-specific imaging appearance. The aim of this review is to describe the imaging spectrum of neurosarcoidosis, including follow-up imaging and superimposed infections, which may occur secondary to immunosuppression. An increased awareness of this great mimicker could potentially expedite diagnosis and reduce morbidity.
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            Challenges in the diagnosis and treatment of neurosarcoidosis.

            The diagnosis and treatment of neurosarcoidosis can be very challenging for several reasons. It affects clinically 5%-10% of sarcoidosis patients, but can be found in up to 25% of autopsies. These data reveal that a high percentage of asymptomatic or misdiagnosed cases can be missed at an initial diagnostic approach. Clinical and imaging findings are often non-specific since they can be found in a large number of neurological disorders. Histopathology can also be confounding if not performed by an expert pathologist and not placed in an appropriate clinical context. In this review, we discuss clinical features, laboratory findings, imaging, and histology of neurosarcoidosis, and we report current evidence regarding drug therapy. We conclude that a correct diagnostic approach should include a multidisciplinary evaluation involving clinicians, radiologists, and pathologists and that future studies should evaluate the genetic signature of neurosarcoidosis as they could be helpful in the assessment of this uncommon disease. With head-to-head comparisons of medical treatment for neurosarcoidosis still lacking due to the rarity of the disease and an increasing number of immunomodulating therapies at hand, novel therapeutic approaches are to be expected within the next few years.
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              Sarcoidosis of the central nervous system: clinical features, imaging, and CSF results

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                Author and article information

                Contributors
                Journal
                Case Rep Med
                Case Rep Med
                CRIM
                Case Reports in Medicine
                Hindawi
                1687-9627
                1687-9635
                2020
                20 April 2020
                : 2020
                Affiliations
                1Departments of Internal Medicine, Instituto Tecnologico y de Estudios Superiores de Monterrey, Monterrey, Mexico
                2Departments of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
                3Departments of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
                4Internal Medicine The University of Texas MD Anderson Cancer Center, Houston, TX, USA
                Author notes

                Academic Editor: Georgios D. Kotzalidis

                Article
                10.1155/2020/9513576
                7191391
                Copyright © 2020 Sahara N. Saltijeral et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Funding
                Funded by: Bryan Tutt in Scientific Publications Services, Research Medical Library
                Categories
                Case Report

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