Neurosarcoidosis Presenting as a Cerebellar Mass
Identifieur interne : 000123 ( Istex/Corpus ); précédent : 000122; suivant : 000124Neurosarcoidosis Presenting as a Cerebellar Mass
Auteurs : Gautam Kumar ; Caroline A. Kang ; Caterina GianniniSource :
- Journal of General Internal Medicine [ 0884-8734 ] ; 2007-09-01.
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Abstract
Abstract: CASE REPORT: A 74-year-old farmer presented with worsening headaches, gait unsteadiness, and writing difficulties. On examination, he had a tendency to fall to the right and right-sided dysmetria and dysdiadochokinesis. Magnetic resonance imaging initially showed abnormalities in the right cerebellar hemisphere, suggestive of subacute infarct or infiltrating malignancy. Suboccipital craniotomy and biopsy revealed noncaseating granulomas suggestive of sarcoidosis. He was initially treated with steroids and later switched to Infliximab. On follow-up 5 months later, symptoms and imaging had improved. DISCUSSION: Sarcoidosis affects the central nervous system in about 5% of patients. It usually manifests with cranial nerve palsies. It may rarely mimic a tumor as in this patient. Despite the dearth of controlled studies addressing neurosarcoidosis treatment, excellent responses to corticosteroids have been documented. Infliximab has been used as a steroid-sparing agent in neurosarcoidosis. We present this case of neurosarcoidosis presenting as a cerebellar mass to increase awareness of this condition.
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DOI: 10.1007/s11606-007-0272-7
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Kang</name><affiliation><mods:affiliation>Department of Neurology, Mayo Clinic, 55905, Rochester, MN, USA</mods:affiliation></affiliation></author><author><name sortKey="Giannini, Caterina" sort="Giannini, Caterina" uniqKey="Giannini C" first="Caterina" last="Giannini">Caterina Giannini</name><affiliation><mods:affiliation>Department of Pathology, Mayo Clinic, 55905, Rochester, MN, USA</mods:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:A0AD04130DE322191A05F25CE8BB58621AD41463</idno><date when="2007" year="2007">2007</date><idno type="doi">10.1007/s11606-007-0272-7</idno><idno type="url">https://api.istex.fr/ark:/67375/VQC-NV7CG1Q0-5/fulltext.pdf</idno><idno type="wicri:Area/Istex/Corpus">000123</idno><idno type="wicri:explorRef" wicri:stream="Istex" wicri:step="Corpus" wicri:corpus="ISTEX">000123</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a" type="main" xml:lang="en">Neurosarcoidosis Presenting as a Cerebellar Mass</title><author><name sortKey="Kumar, Gautam" sort="Kumar, Gautam" uniqKey="Kumar G" first="Gautam" last="Kumar">Gautam Kumar</name><affiliation><mods:affiliation>Department of Internal Medicine, Mayo Clinic, 200 2nd Street SW, 55905, Rochester, MN, USA</mods:affiliation></affiliation><affiliation><mods:affiliation>E-mail: kumar.gautam@mayo.edu</mods:affiliation></affiliation></author><author><name sortKey="Kang, Caroline A" sort="Kang, Caroline A" uniqKey="Kang C" first="Caroline A." last="Kang">Caroline A. Kang</name><affiliation><mods:affiliation>Department of Neurology, Mayo Clinic, 55905, Rochester, MN, USA</mods:affiliation></affiliation></author><author><name sortKey="Giannini, Caterina" sort="Giannini, Caterina" uniqKey="Giannini C" first="Caterina" last="Giannini">Caterina Giannini</name><affiliation><mods:affiliation>Department of Pathology, Mayo Clinic, 55905, Rochester, MN, USA</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">Journal of General Internal Medicine</title><title level="j" type="abbrev">J GEN INTERN MED</title><idno type="ISSN">0884-8734</idno><idno type="eISSN">1525-1497</idno><imprint><publisher>Springer-Verlag</publisher><pubPlace>New York</pubPlace><date type="published" when="2007-09-01">2007-09-01</date><biblScope unit="volume">22</biblScope><biblScope unit="issue">9</biblScope><biblScope unit="page" from="1373">1373</biblScope><biblScope unit="page" to="1376">1376</biblScope></imprint><idno type="ISSN">0884-8734</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0884-8734</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Infliximab</term><term>cerebellar mass</term><term>neurosarcoidosis</term></keywords></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Abstract: CASE REPORT: A 74-year-old farmer presented with worsening headaches, gait unsteadiness, and writing difficulties. On examination, he had a tendency to fall to the right and right-sided dysmetria and dysdiadochokinesis. Magnetic resonance imaging initially showed abnormalities in the right cerebellar hemisphere, suggestive of subacute infarct or infiltrating malignancy. Suboccipital craniotomy and biopsy revealed noncaseating granulomas suggestive of sarcoidosis. He was initially treated with steroids and later switched to Infliximab. On follow-up 5 months later, symptoms and imaging had improved. DISCUSSION: Sarcoidosis affects the central nervous system in about 5% of patients. It usually manifests with cranial nerve palsies. It may rarely mimic a tumor as in this patient. Despite the dearth of controlled studies addressing neurosarcoidosis treatment, excellent responses to corticosteroids have been documented. Infliximab has been used as a steroid-sparing agent in neurosarcoidosis. We present this case of neurosarcoidosis presenting as a cerebellar mass to increase awareness of this condition.</div></front></TEI><istex><corpusName>springer-journals</corpusName><author><json:item><name>Gautam Kumar MBBS, MRCP(UK)</name><affiliations><json:string>Department of Internal Medicine, Mayo Clinic, 200 2nd Street SW, 55905, Rochester, MN, USA</json:string><json:string>E-mail: kumar.gautam@mayo.edu</json:string></affiliations></json:item><json:item><name>Caroline A. 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On examination, he had a tendency to fall to the right and right-sided dysmetria and dysdiadochokinesis. Magnetic resonance imaging initially showed abnormalities in the right cerebellar hemisphere, suggestive of subacute infarct or infiltrating malignancy. Suboccipital craniotomy and biopsy revealed noncaseating granulomas suggestive of sarcoidosis. He was initially treated with steroids and later switched to Infliximab. On follow-up 5 months later, symptoms and imaging had improved. DISCUSSION: Sarcoidosis affects the central nervous system in about 5% of patients. It usually manifests with cranial nerve palsies. It may rarely mimic a tumor as in this patient. Despite the dearth of controlled studies addressing neurosarcoidosis treatment, excellent responses to corticosteroids have been documented. Infliximab has been used as a steroid-sparing agent in neurosarcoidosis. 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On examination, he had a tendency to fall to the right and right-sided dysmetria and dysdiadochokinesis. Magnetic resonance imaging initially showed abnormalities in the right cerebellar hemisphere, suggestive of subacute infarct or infiltrating malignancy. Suboccipital craniotomy and biopsy revealed noncaseating granulomas suggestive of sarcoidosis. He was initially treated with steroids and later switched to Infliximab. On follow-up 5 months later, symptoms and imaging had improved. DISCUSSION: Sarcoidosis affects the central nervous system in about 5% of patients. It usually manifests with cranial nerve palsies. It may rarely mimic a tumor as in this patient. Despite the dearth of controlled studies addressing neurosarcoidosis treatment, excellent responses to corticosteroids have been documented. Infliximab has been used as a steroid-sparing agent in neurosarcoidosis. 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TocLevels="0"><ArticleID>272</ArticleID><ArticleDOI>10.1007/s11606-007-0272-7</ArticleDOI><ArticleSequenceNumber>23</ArticleSequenceNumber><ArticleTitle Language="En">Neurosarcoidosis Presenting as a Cerebellar Mass</ArticleTitle><ArticleCategory>Case Reports/Clinical Vignettes</ArticleCategory><ArticleFirstPage>1373</ArticleFirstPage><ArticleLastPage>1376</ArticleLastPage><ArticleHistory><RegistrationDate><Year>2007</Year><Month>6</Month><Day>18</Day></RegistrationDate><Received><Year>2006</Year><Month>12</Month><Day>1</Day></Received><Revised><Year>2007</Year><Month>4</Month><Day>17</Day></Revised><Accepted><Year>2007</Year><Month>6</Month><Day>15</Day></Accepted><OnlineDate><Year>2007</Year><Month>7</Month><Day>6</Day></OnlineDate></ArticleHistory><ArticleCopyright><CopyrightHolderName>Society of General Internal Medicine</CopyrightHolderName><CopyrightYear>2007</CopyrightYear></ArticleCopyright><ArticleGrants Type="Regular"><MetadataGrant Grant="OpenAccess"></MetadataGrant><AbstractGrant Grant="OpenAccess"></AbstractGrant><BodyPDFGrant Grant="Restricted"></BodyPDFGrant><BodyHTMLGrant Grant="Restricted"></BodyHTMLGrant><BibliographyGrant Grant="Restricted"></BibliographyGrant><ESMGrant Grant="Restricted"></ESMGrant></ArticleGrants></ArticleInfo><ArticleHeader><AuthorGroup><Author AffiliationIDS="Aff1" CorrespondingAffiliationID="Aff1"><AuthorName DisplayOrder="Western"><GivenName>Gautam</GivenName><FamilyName>Kumar</FamilyName><Degrees>MBBS, MRCP(UK)</Degrees></AuthorName><Contact><Phone>+1-507-2842511</Phone><Fax>+1-507-2840161</Fax><Email>kumar.gautam@mayo.edu</Email></Contact></Author><Author AffiliationIDS="Aff2"><AuthorName DisplayOrder="Western"><GivenName>Caroline</GivenName><GivenName>A.</GivenName><FamilyName>Kang</FamilyName><Degrees>MD</Degrees></AuthorName></Author><Author AffiliationIDS="Aff3"><AuthorName DisplayOrder="Western"><GivenName>Caterina</GivenName><FamilyName>Giannini</FamilyName><Degrees>MD</Degrees></AuthorName></Author><Affiliation ID="Aff1"><OrgDivision>Department of Internal Medicine</OrgDivision><OrgName>Mayo Clinic</OrgName><OrgAddress><Street>200 2nd Street SW</Street><City>Rochester</City><State>MN</State><Postcode>55905</Postcode><Country Code="US">USA</Country></OrgAddress></Affiliation><Affiliation ID="Aff2"><OrgDivision>Department of Neurology</OrgDivision><OrgName>Mayo Clinic</OrgName><OrgAddress><City>Rochester</City><State>MN</State><Postcode>55905</Postcode><Country Code="US">USA</Country></OrgAddress></Affiliation><Affiliation ID="Aff3"><OrgDivision>Department of Pathology</OrgDivision><OrgName>Mayo Clinic</OrgName><OrgAddress><City>Rochester</City><State>MN</State><Postcode>55905</Postcode><Country Code="US">USA</Country></OrgAddress></Affiliation></AuthorGroup><Abstract ID="Abs1" Language="En"><Heading>Abstract</Heading><AbstractSection ID="ASec1"><Heading>CASE REPORT</Heading><Para>A 74-year-old farmer presented with worsening headaches, gait unsteadiness, and writing difficulties. On examination, he had a tendency to fall to the right and right-sided dysmetria and dysdiadochokinesis. Magnetic resonance imaging initially showed abnormalities in the right cerebellar hemisphere, suggestive of subacute infarct or infiltrating malignancy. Suboccipital craniotomy and biopsy revealed noncaseating granulomas suggestive of sarcoidosis. He was initially treated with steroids and later switched to Infliximab. On follow-up 5 months later, symptoms and imaging had improved.</Para></AbstractSection><AbstractSection ID="ASec2"><Heading>DISCUSSION</Heading><Para>Sarcoidosis affects the central nervous system in about 5% of patients. It usually manifests with cranial nerve palsies. It may rarely mimic a tumor as in this patient. Despite the dearth of controlled studies addressing neurosarcoidosis treatment, excellent responses to corticosteroids have been documented. Infliximab has been used as a steroid-sparing agent in neurosarcoidosis. We present this case of neurosarcoidosis presenting as a cerebellar mass to increase awareness of this condition.</Para></AbstractSection></Abstract><KeywordGroup Language="En"><Heading>KEY WORDS</Heading><Keyword>neurosarcoidosis</Keyword><Keyword>Infliximab</Keyword><Keyword>cerebellar mass</Keyword></KeywordGroup></ArticleHeader><NoBody></NoBody></Article></Issue></Volume></Journal></Publisher></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>Neurosarcoidosis Presenting as a Cerebellar Mass</title></titleInfo><titleInfo type="alternative" contentType="CDATA"><title>Neurosarcoidosis Presenting as a Cerebellar Mass</title></titleInfo><name type="personal" displayLabel="corresp"><namePart type="given">Gautam</namePart><namePart type="family">Kumar</namePart><namePart type="termsOfAddress">MBBS, MRCP(UK)</namePart><affiliation>Department of Internal Medicine, Mayo Clinic, 200 2nd Street SW, 55905, Rochester, MN, USA</affiliation><affiliation>E-mail: kumar.gautam@mayo.edu</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Caroline</namePart><namePart type="given">A.</namePart><namePart type="family">Kang</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Department of Neurology, Mayo Clinic, 55905, Rochester, MN, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Caterina</namePart><namePart type="family">Giannini</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Department of Pathology, Mayo Clinic, 55905, Rochester, MN, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="OriginalPaper" authority="ISTEX" authorityURI="https://content-type.data.istex.fr" valueURI="https://content-type.data.istex.fr/ark:/67375/XTP-1JC4F85T-7">research-article</genre><originInfo><publisher>Springer-Verlag</publisher><place><placeTerm type="text">New York</placeTerm></place><dateCreated encoding="w3cdtf">2006-12-01</dateCreated><dateIssued encoding="w3cdtf">2007-09-01</dateIssued><copyrightDate encoding="w3cdtf">2007</copyrightDate></originInfo><language><languageTerm type="code" authority="rfc3066">en</languageTerm><languageTerm type="code" authority="iso639-2b">eng</languageTerm></language><abstract lang="en">Abstract: CASE REPORT: A 74-year-old farmer presented with worsening headaches, gait unsteadiness, and writing difficulties. On examination, he had a tendency to fall to the right and right-sided dysmetria and dysdiadochokinesis. Magnetic resonance imaging initially showed abnormalities in the right cerebellar hemisphere, suggestive of subacute infarct or infiltrating malignancy. Suboccipital craniotomy and biopsy revealed noncaseating granulomas suggestive of sarcoidosis. He was initially treated with steroids and later switched to Infliximab. On follow-up 5 months later, symptoms and imaging had improved. DISCUSSION: Sarcoidosis affects the central nervous system in about 5% of patients. It usually manifests with cranial nerve palsies. It may rarely mimic a tumor as in this patient. Despite the dearth of controlled studies addressing neurosarcoidosis treatment, excellent responses to corticosteroids have been documented. Infliximab has been used as a steroid-sparing agent in neurosarcoidosis. 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