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Lin J, Pulst-Korenberg J, Zamvil SS, Graves J, Newsome SD, Amezcua L. Tuberculous Meningitis or Neurosarcoidosis-a Diagnostic Quandary. From the National Multiple Sclerosis Society Case Conference Proceedings. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2024; 11:e200184. [PMID: 38118077 PMCID: PMC10732344 DOI: 10.1212/nxi.0000000000200184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 10/05/2023] [Indexed: 12/22/2023]
Abstract
Distinguishing granulomatous diseases remains diagnostically challenging. Clinical phenotypes and neuroimaging findings resemble many infectious and noninfectious disorders. We describe a Hispanic/Latino man diagnosed with tuberculous meningitis who deteriorated neurologically after treatments. Additional workup revealed a pathology more consistent with neurosarcoidosis. Care access delays and social circumstances likely complicated his diagnosis.
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Affiliation(s)
- Jia Lin
- From the Department of Neurology (J.L., J.P.-K., L.A.), University of Southern California, Keck School of Medicine, Los Angeles; Department of Neurology (S.S.Z.), University of California San Francisco; Department of Neurosciences (J.G.), University of California San Diego; and Department of Neurology and Neurosurgery (S.D.N.), Johns Hopkins University, Baltimore, MD
| | - Johannes Pulst-Korenberg
- From the Department of Neurology (J.L., J.P.-K., L.A.), University of Southern California, Keck School of Medicine, Los Angeles; Department of Neurology (S.S.Z.), University of California San Francisco; Department of Neurosciences (J.G.), University of California San Diego; and Department of Neurology and Neurosurgery (S.D.N.), Johns Hopkins University, Baltimore, MD
| | - Scott S Zamvil
- From the Department of Neurology (J.L., J.P.-K., L.A.), University of Southern California, Keck School of Medicine, Los Angeles; Department of Neurology (S.S.Z.), University of California San Francisco; Department of Neurosciences (J.G.), University of California San Diego; and Department of Neurology and Neurosurgery (S.D.N.), Johns Hopkins University, Baltimore, MD
| | - Jennifer Graves
- From the Department of Neurology (J.L., J.P.-K., L.A.), University of Southern California, Keck School of Medicine, Los Angeles; Department of Neurology (S.S.Z.), University of California San Francisco; Department of Neurosciences (J.G.), University of California San Diego; and Department of Neurology and Neurosurgery (S.D.N.), Johns Hopkins University, Baltimore, MD
| | - Scott D Newsome
- From the Department of Neurology (J.L., J.P.-K., L.A.), University of Southern California, Keck School of Medicine, Los Angeles; Department of Neurology (S.S.Z.), University of California San Francisco; Department of Neurosciences (J.G.), University of California San Diego; and Department of Neurology and Neurosurgery (S.D.N.), Johns Hopkins University, Baltimore, MD
| | - Lilyana Amezcua
- From the Department of Neurology (J.L., J.P.-K., L.A.), University of Southern California, Keck School of Medicine, Los Angeles; Department of Neurology (S.S.Z.), University of California San Francisco; Department of Neurosciences (J.G.), University of California San Diego; and Department of Neurology and Neurosurgery (S.D.N.), Johns Hopkins University, Baltimore, MD
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Cavone F, Cappelli S, Bonuccelli A, D’Elios S, Costagliola G, Peroni D, Orsini A, Consolini R. Ataxia Telangiectasia Arising as Immunodeficiency: The Intriguing Differential Diagnosis. J Clin Med 2023; 12:6041. [PMID: 37762981 PMCID: PMC10531840 DOI: 10.3390/jcm12186041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/29/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
Ataxia telangiectasia (AT) is a rare disease characterized by the early onset and slow progression of neurodegenerative defects, mainly affecting the cerebellum, associated with immunodeficiency and teleangiectasias. Ataxia is the hallmark of the disease and usually its first manifestation. Overt cerebellar ataxia usually becomes evident between 16 and 18 months of age, after the onset of walking, and is characterized by frequent falls and an ataxic gait with an enlarged base. We report the case of a child who first presented with serious recurrent infectious, without exhibiting neurological symptoms. The patient was initially diagnosed with combined immunodeficiency (CID) of unknown etiology for nearly 3 years, before he was definitively diagnosed with ataxia telangiectasia.
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Affiliation(s)
- Federica Cavone
- Pediatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (F.C.); (G.C.); (D.P.)
| | - Susanna Cappelli
- Section of Clinical and Laboratory Immunology, Division of Pediatrics, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (S.C.); (S.D.)
| | - Alice Bonuccelli
- Section of Pediatric Neurology, Division of Pediatrics, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (A.B.); (A.O.)
| | - Sofia D’Elios
- Section of Clinical and Laboratory Immunology, Division of Pediatrics, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (S.C.); (S.D.)
| | - Giorgio Costagliola
- Pediatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (F.C.); (G.C.); (D.P.)
| | - Diego Peroni
- Pediatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (F.C.); (G.C.); (D.P.)
| | - Alessandro Orsini
- Section of Pediatric Neurology, Division of Pediatrics, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (A.B.); (A.O.)
| | - Rita Consolini
- Section of Clinical and Laboratory Immunology, Division of Pediatrics, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (S.C.); (S.D.)
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Naccarella N, Ikhlef S, Rommens J. Neurosarcoidosis With Multi-Organ Involvement: A Case Report and Literature Review. Cureus 2023; 15:e43254. [PMID: 37692752 PMCID: PMC10491999 DOI: 10.7759/cureus.43254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2023] [Indexed: 09/12/2023] Open
Abstract
Sarcoidosis is a multisystemic disease that, in rare cases, can involve the central nervous system (CNS). We present a case of sarcoidosis with intracranial and multi-organ involvement. The patient presented with a one-month history of headaches. Imaging revealed leptomeningeal nodular enhancement (LNE), and a PET/CT scan of the chest and abdomen showed bilateral hilar, retroperitoneal, and inguinal lymphadenopathy. The diagnosis of sarcoidosis was confirmed by an ultrasound-guided inguinal lymph node biopsy. The patient was started on a combination of corticosteroids and immunosuppressive drugs, with a gradual improvement in symptoms and radiological findings over several months.
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Affiliation(s)
- Nicolas Naccarella
- Department of Radiology/Interventional Radiology, Hôpital Universitaire de Bruxelles (H.U.B), Brussels, BEL
| | - Samia Ikhlef
- Department of Radiology, Hôpital Universitaire de Bruxelles (H.U.B), Brussels, BEL
| | - Jacques Rommens
- Department of Radiology/Interventional Radiology, Hôpital Delta, Chirec, Brussels, BEL
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Aktan Suzgun M, Erener N, Cavus GH, Ozdede A, Guner S, Ugurlu S, Comunoglu N, Kizilkilic O, Saip S. A review of rheumatoid meningitis with case studies. Mod Rheumatol Case Rep 2023; 7:340-346. [PMID: 36718604 DOI: 10.1093/mrcr/rxad010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/17/2022] [Accepted: 01/04/2023] [Indexed: 02/01/2023]
Abstract
Rheumatoid arthritis (RA) is an autoimmune disease involving synovial joints, and it is known that extra-articular manifestations that may affect the central and peripheral nervous systems may develop during its course. Rheumatoid meningitis is very rare among all neurological involvements. In this study, cases diagnosed as rheumatoid meningitis with clinical, imaging, laboratory, and histopathological features are presented, and the aim of the study is to present current approaches in the diagnosis and treatment of rheumatoid meningitis in the light of case studies and current literature. The data of the patients who were followed up with the diagnosis of rheumatoid meningitis in neurology clinic between 2017 and 2021 were reviewed retrospectively. Three cases diagnosed with rheumatoid meningitis are presented in detail. In the first case, the diagnosis was reached by clinical, imaging, and laboratory findings as well as treatment response, while the diagnosis was made by histopathological verification in the second case. The third case shows that spontaneous remission can be observed in the course of rheumatoid meningitis. Rheumatoid meningitis, which is one of the rarest involvements in the course of RA, may present with headaches, focal neurological deficits, seizures, and altered consciousness. A meningeal biopsy is recommended when the differential diagnosis cannot be ruled out with imaging and laboratory findings. In the differential diagnosis Mucobacterium tuberculosis, syphilis, neuro-sarcoidosis, immunoglobulin G4-related disease, lymphoproliferative diseases, and systemic metastasis should be kept in mind. Aggressive RA management is recommended for treatment.
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Affiliation(s)
- Merve Aktan Suzgun
- Department of Neurology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Nursena Erener
- Department of Neurology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Gokce Hande Cavus
- Department of Pathology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ayse Ozdede
- Department of Rheumatology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Sabriye Guner
- Department of Rheumatology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Serdal Ugurlu
- Department of Rheumatology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Nil Comunoglu
- Department of Pathology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Osman Kizilkilic
- Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Sabahattin Saip
- Department of Neurology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Zhao Q, Li P, Peng R, Huang H, Ding X, Wang J, Xiao B, Zhou L. Disseminated central nervous system sparganosis appearing as meningeal granulomatous disease diagnosed by next-generation sequencing. Neurol Sci 2023; 44:1823-1826. [PMID: 36637624 DOI: 10.1007/s10072-022-06596-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 12/27/2022] [Indexed: 01/14/2023]
Affiliation(s)
- Qianqian Zhao
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Peihong Li
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Renjun Peng
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - He Huang
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xiping Ding
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Junling Wang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Bo Xiao
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Luo Zhou
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China.
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Yue JK, Lee YM, Quintana D, Aabedi AA, Krishnan N, Wozny TA, Andrews JP, Huang MC. Paraparesis caused by intradural thoracic spinal granuloma secondary to organizing hematoma: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2022; 4:CASE22432. [PMID: 36411545 PMCID: PMC9678799 DOI: 10.3171/case22432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 10/24/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Spinal granulomas form from infectious or noninfectious inflammatory processes and are rarely present intradurally. Intradural granulomas secondary to hematoma are unreported in the literature and present diagnostic and management challenges. OBSERVATIONS A 70-year-old man receiving aspirin presented with encephalopathy, subacute malaise, and right lower extremity weakness and was diagnosed with polysubstance withdrawal and refractory hypertension requiring extended treatment. Seven days after admission, he reported increased bilateral lower extremity (BLE) weakness. Magnetic resonance imaging showed T2-3 and T7-8 masses abutting the pia, with spinal cord compression at T2-3. He was transferred to the authors' institution, and work-up showed no vascular shunting or malignancy. He underwent T2-3 laminectomies for biopsy/resection. A firm, xanthochromic mass was resected en bloc. Pathology showed organizing hematoma without infection, vascular malformation, or malignancy. Subsequent coagulopathy work-up was unremarkable. His BLE strength significantly improved, and he declined resection of the inferior mass. He completed physical therapy and was cleared for placement in a skilled nursing facility. LESSONS Spinal granulomas can mimic vascular lesions and malignancy. The authors present the first report of paraparesis caused by intradural granuloma secondary to organizing hematoma, preceded by severe refractory hypertension. Tissue diagnosis is critical, and resection is curative. These findings can inform the vigilant clinician for expeditious treatment.
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Affiliation(s)
- John K. Yue
- Department of Neurosurgery, University of California, San Francisco, San Francisco, California; and ,Department of Neurosurgery, Veterans Affairs Medical Center, San Francisco, California
| | - Young M. Lee
- Department of Neurosurgery, University of California, San Francisco, San Francisco, California; and ,Department of Neurosurgery, Veterans Affairs Medical Center, San Francisco, California
| | - Daniel Quintana
- Department of Neurosurgery, University of California, San Francisco, San Francisco, California; and ,Department of Neurosurgery, Veterans Affairs Medical Center, San Francisco, California
| | - Alexander A. Aabedi
- Department of Neurosurgery, University of California, San Francisco, San Francisco, California; and ,Department of Neurosurgery, Veterans Affairs Medical Center, San Francisco, California
| | - Nishanth Krishnan
- Department of Neurosurgery, University of California, San Francisco, San Francisco, California; and ,Department of Neurosurgery, Veterans Affairs Medical Center, San Francisco, California
| | - Thomas A. Wozny
- Department of Neurosurgery, University of California, San Francisco, San Francisco, California; and ,Department of Neurosurgery, Veterans Affairs Medical Center, San Francisco, California
| | - John P. Andrews
- Department of Neurosurgery, University of California, San Francisco, San Francisco, California; and ,Department of Neurosurgery, Veterans Affairs Medical Center, San Francisco, California
| | - Michael C. Huang
- Department of Neurosurgery, University of California, San Francisco, San Francisco, California; and ,Department of Neurosurgery, Veterans Affairs Medical Center, San Francisco, California
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