Profile of neurosarcoidosis observed in internal medecine practice
D. Zemmour, D. hakem, S. Fédala-Haddam, M. Yagoubi, M. Abada-Bendib, F. Kessaci & A. Berrah
Introduction: Neurological achievements of sarcoidosis or neurosarcoidosis NS is rare (5%), but revealing of the disease in 50%. Neurological and endocrinous signs vary according to the topography of the damage. Cerebral forms results from the infiltration of the meningeal spaces, the granulomatous process spreads secondarily in the cerebral and spinal nerves, in the vessels and in the cerebral parenchyma. NS are individualized better with the contribution of the neuro-imaging. Precocity of the diagnosis improves the prognosis.
Objectives: To review through some case reports clinical polymorphism of the NS and the diagnostic and therapeutic difficulties observed.
Patients and methods: Retrospective Study over five consecutive years on January 2005-December 2010.
Results: In total, 11 inclusive patients, 9 Women and 2 Men, age means 37 2 years (2456). Achievement is encephalic (5), medullar (2) and orbital (3). Its joins to a hypothalamic-pituitary localization (4), thoracic (5), cutaneous (4, liver (2), eyes (3) and is inaugural at three patients. Revealing clinical pictures are intracranial hypertension ICH (4), inflammatory tumour of the orbit (2), myelitis (2) and endocrines signs as insipid diabetes or hypopituitarism (4). Treatment imposes hormonal substitution, immunosuppressive drugs (4) and peritoneal derivation (2). The course is fatal (1), conducts to cognitive disorders (2), to definitive endocrine insufficiency (3), sever osteoporosis (3), optic atrophy (1) and to meningeal infections (2).
Discussion: NS is polymorphous with hypothalamic-pituitary achievements, ICHT, pseudo-tumour of the orbit, etc. witch constitute circumstances of diagnostic wandering, and sometimes compromise the prognosis by their resistance of corticoadrenal therapy and the secondary infections caused by a lymphocytopenia and an adverse effects of therapy.
Conclusion: NS diagnosis is based (after exclusion any infectious or tumour process), on the identification of a neurological localization accessible to identify the sarcoidal granuloma. MRI is at present a decisive element for the diagnosis and the monitoring of the NS. Considering the functional and vital risks of this a corticotherapy must be prematurely prescribed.
Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.
Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.