Saturday, February 06, 2010

Neurosarcoidosis pearls diagnosis

1.  Percent with cranial neuropathy-- 50-75 (most common VII, second II, all can be affected)
2.  Percent with parenchymal brain lesions-50
3.  Other manifestations - cognitive 20, meningeal 10-20, PN 15, seizures 5-10, spinal 5-10, myopathy 1.4-2.3
4.  Neuroendocrine presentations may include polydipsia, polyuria, panhypopituitarism, or massive obesity if sarcoid invades satiety center of hypothalamus
5.  Neuropathy can be virtually any type
6.  Myopathy can be acute, chronic or nodular and is usually subclinical. In contrast to steroid myopathy (the rule-out diagnosis often), sarcoid myopathy may have palpable nodules, contractures, cramps, elevated CPK, and fibrillation potentials and positive sharp waves on EMG.  Both steroid and sarcoid myopathy will have myopathic potentials.
7.  Contrast enhanced MRI to look for meningeal involvement is extremely important, but is not specific.
8.  Whole body PET imaging is better than Gallium and can be used to look for lymph nodes suitable for biopsy for diagnosis, but is not specific
9. CSF is normal in one third,but can show high protein, lymphocytosis, low glucose. OCB's , high IgG index
10.  CSF ACE levels are insensitive (24-55 %) but fairly specific (93%) for CNS sarcoid
11.  Heerfordt's syndrome consists of facial palsy, parotid enlargement, uveitis and fever and is considered so typical that tissue biopsy is not required

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