Abstract Details

Title Neurosarcoidosis with Extensive Leptomeningeal Involvement

Topic Neurotoxicology

Presentation(s) P06 - (-)

Poster/Presentation
Number 200

Objective

Background BACKGROUND: Neurosarcoidosis is a condition consisting of non-caseating granulomas affecting the central nervous system, most commonly in the cranial nerves, especially the facial nerve. Visual problems may also be the result of papilledema that is by obstruction of normal cerebrospinal fluid circulation by granulomas. Some cases also present with aseptic meningitis.

Design/Methods DESIGN/METHODS: Literature search and review.

Results RESULTS: A 45 year old African American woman had episodes of fever, nausea, vomiting, transient visual loss lasting for minutes, and progressive weakness in her lower extremities. She was initially diagnosed with possible TB meningitis based on CSF studies showing glucose 23 mg/dl, protein 131 mg/dl, lymphocytes 61 and possible TB exposure. MRI showed leptomeningeal enhancement in the basal cisterns. She was treated with anti-tuberculosis four-drug regimen. She was readmitted for mental status changes with visual hallucinations and blurry vision one year later. Neurological exam revealed papilledema, left cranial nerve VI palsy, asymmetric upper and lower extremity weakness, and marked sensory ataxia. CSF analysis showed glucose 23 mg/dl, protein 224 mg/dl, and lymphocytes of 61. ACE level was elevated 65 mg/dl. AFB culture, PCR, PPD, and quantiferon tests were all negative. CT abdomen/pelvis showed adenopathy. MRI showed hypothalamic enhancement causing secondary hypothyroidism and diffuse leptomeningeal enhancement involving the whole cervical, thoracic, and lumbosacral spine. Neurosarcoidosis was confirmed by brain biopsy. Patient was initially started on prednisone 60 mg daily with resolved symptoms in a few months and maintained at methotrexate at 10 mg weekly.

Conclusions CONCLUSIONS: Neurosarcoidosis can present with acute and chronic aseptic meningitis with multiple cranial nerve palsies, limb motor and sensory deficits, neuroendocrine disturbances, and diffuse, extensive leptomeningeal gadolinium enhancement mimicking TB infectiin, other inflammatory, or neoplastic disorders.

Authors/Disclosures
Husain M. Rizvi, MD (North Shore University Hospital) PRESENTER	Dr. Rizvi has nothing to disclose.
	No disclosure on file
Shan Chen, MD, PhD (Rutgers-Robert Wood Johnson Medical School)	Dr. Chen has nothing to disclose.
Teri Schreiner, MD, MPH, FAAN (University of Colorado/ Children's Hospital of Colorado)	The institution of Dr. Schreiner has received personal compensation in the range of $500-$4,999 for serving as a Consultant for CDC. Dr. Schreiner has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. The institution of Dr. Schreiner has received research support from Roche Genentech.

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