Central nervous system sarcoidosis—diagnosis and management
Identifieur interne : 002687 ( Main/Exploration ); précédent : 002686; suivant : 002688Central nervous system sarcoidosis—diagnosis and management
Auteurs : J. P. Zajicek ; N. J. Scolding ; O. Foster ; M. Rovaris ; J. Evanson ; I. F. Moseley ; J. W. Scadding ; E. J. Thompson ; V. Chamoun ; D. H. Miller ; W. I. Mcdonald ; D. Mitchell [Royaume-Uni]Source :
- QJM [ 1460-2725 ] ; 1999.
Abstract
A series of 68 patients with neurosarcoidosis is reported, with particular emphasis on clinical aspects, diagnosis and treatment. A classification system based on clinical diagnostic probability is proposed, consisting of probable and definite disease, the latter being dependent on finding sarcoid granulomas on nervous system histology, which was obtained in 12 patients (18%). The role of investigations, including magnetic resonance imaging (MRI), chest radiography, Kveim skin test, Gallium 67 isotope scanning and cerebrospinal fluid (CSF) studies, is considered. Sixty-two percent of patients presented with nervous system disease, most commonly affecting the optic nerve and chiasm. Other common presentations included cranial nerve palsies, spinal cord and brainstem manifestations. Investigations yielding most diagnostic information included the Kveim test (41/48, 85% positive), raised CSF protein and/or cells (50/62, 81%) and gallium 67 scan (14/31, 45%). Eleven out of 29 patients (38%) patients showed meningeal enhancement on MRI scanning and 43% of scans demonstrated multiple white-matter lesions. Mean follow-up for the group was 4.6 years. Forty-seven patients were seen for >18 months, and over half of these patients progressed despite corticosteroid and other immunosuppressive therapies. The benefit of a large patient database prospectively studied, with extended follow-up is discussed in order to learn more about prognosis and advance therapy in neurosarcoidosis.
Url:
DOI: 10.1093/qjmed/92.2.103
Affiliations:
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Mitchell</name><affiliation wicri:level="3"><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Royal Brompton Hospital, London</wicri:regionArea><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation></author></analytic><monogr></monogr><series><title level="j" type="main">QJM</title><title level="j" type="abbrev">QJM</title><idno type="ISSN">1460-2725</idno><idno type="eISSN">1460-2393</idno><imprint><publisher>Oxford University Press</publisher><date when="1999-02">1999</date><biblScope unit="vol">92</biblScope><biblScope unit="issue">2</biblScope><biblScope unit="page" from="103">103</biblScope><biblScope unit="page" to="117">117</biblScope></imprint><idno type="ISSN">1460-2725</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">1460-2725</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">A series of 68 patients with neurosarcoidosis is reported, with particular emphasis on clinical aspects, diagnosis and treatment. A classification system based on clinical diagnostic probability is proposed, consisting of probable and definite disease, the latter being dependent on finding sarcoid granulomas on nervous system histology, which was obtained in 12 patients (18%). The role of investigations, including magnetic resonance imaging (MRI), chest radiography, Kveim skin test, Gallium 67 isotope scanning and cerebrospinal fluid (CSF) studies, is considered. Sixty-two percent of patients presented with nervous system disease, most commonly affecting the optic nerve and chiasm. Other common presentations included cranial nerve palsies, spinal cord and brainstem manifestations. Investigations yielding most diagnostic information included the Kveim test (41/48, 85% positive), raised CSF protein and/or cells (50/62, 81%) and gallium 67 scan (14/31, 45%). Eleven out of 29 patients (38%) patients showed meningeal enhancement on MRI scanning and 43% of scans demonstrated multiple white-matter lesions. Mean follow-up for the group was 4.6 years. Forty-seven patients were seen for >18 months, and over half of these patients progressed despite corticosteroid and other immunosuppressive therapies. The benefit of a large patient database prospectively studied, with extended follow-up is discussed in order to learn more about prognosis and advance therapy in neurosarcoidosis.</div></front></TEI><affiliations><list><country><li>Royaume-Uni</li></country><region><li>Angleterre</li><li>Grand Londres</li></region><settlement><li>Londres</li></settlement></list><tree><noCountry><name sortKey="Chamoun, V" sort="Chamoun, V" uniqKey="Chamoun V" first="V." last="Chamoun">V. Chamoun</name><name sortKey="Evanson, J" sort="Evanson, J" uniqKey="Evanson J" first="J." last="Evanson">J. Evanson</name><name sortKey="Foster, O" sort="Foster, O" uniqKey="Foster O" first="O." last="Foster">O. Foster</name><name sortKey="Mcdonald, W I" sort="Mcdonald, W I" uniqKey="Mcdonald W" first="W. I." last="Mcdonald">W. I. Mcdonald</name><name sortKey="Miller, D H" sort="Miller, D H" uniqKey="Miller D" first="D. H." last="Miller">D. H. Miller</name><name sortKey="Moseley, I F" sort="Moseley, I F" uniqKey="Moseley I" first="I. F." last="Moseley">I. F. Moseley</name><name sortKey="Rovaris, M" sort="Rovaris, M" uniqKey="Rovaris M" first="M." last="Rovaris">M. Rovaris</name><name sortKey="Scadding, J W" sort="Scadding, J W" uniqKey="Scadding J" first="J. W." last="Scadding">J. W. Scadding</name><name sortKey="Scolding, N J" sort="Scolding, N J" uniqKey="Scolding N" first="N. J." last="Scolding">N. J. Scolding</name><name sortKey="Thompson, E J" sort="Thompson, E J" uniqKey="Thompson E" first="E. J." last="Thompson">E. J. Thompson</name><name sortKey="Zajicek, J P" sort="Zajicek, J P" uniqKey="Zajicek J" first="J. P." last="Zajicek">J. P. Zajicek</name></noCountry><country name="Royaume-Uni"><region name="Angleterre"><name sortKey="Mitchell, D" sort="Mitchell, D" uniqKey="Mitchell D" first="D." last="Mitchell">D. Mitchell</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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