Нейросаркоидозɸ — клинико-диагностические аспекты. Лечение пациента с нейросаркоидозом: клинический случай

Abstract

INTRODUCTION. The complexity of neurosarcoidosis is due to the wide variety of clinical manifestations and variability of signs of concomitant systemic diseases. AIM. To analyze literature data on diagnostic features, clinical manifestations of neurosarcoidosis, and our experience in treating a patient with neurosarcoidosis. MATERIAL AND METHODS. A literature analysis was performed for the period from 2012–2024 28 literary sources (PubMed database) were analyzed, on the basis of which a description of the clinical manifestations and diagnostic methods of neurosarcoidosis was made. Data on the main approaches to the differential diagnosis of the disease are presented, neurological manifestations, imaging results, manifestations of spinal lesions and meningeal lesions in neurosarcoidosis are described in detail. A clinical case is presented.RESULTS AND DISCUSSION. Based on current clinic al guidelines, to diagnose neurosarcoidosis, a patient must have appropriate clinical neurological manifestations and rule out other causes. The results of the biopsy reveal the presence of signs of granulomatous inflammation, and an accurate diagnosis of neurosarcoidosis is made. Key symptoms of neurosarcoidosis in all cases include the presence of infections (tuberculosis, fungal), autoimmune diseases (vasculitis, IgG4-related diseases), lymphoma. Because neurosarcoidosis can affect any part of the nervous system, it is necessary to attempt to establish a unique differential diagnosis tailored to the clinical picture. There are no serum markers that can clearly distinguish sarcoidosis from its mimicking manifestations. Neuroimaging remains an important tool in the diagnosis of sarcoidosis. Contrast-enhanced magnetic resonance imaging is the imaging modality of choice for neurosarcoidosis because it can detect enhancement consistent with active inflammation. CASE PRESENTATION. A clinical case of neurosarcoidosis is presented: a 30-year-old man who was hospitalized with suspected intracerebral hemorrhage. Previously, there were episodes of clouding of consciousness with elements of aggressive behavior, hallucinations, and memory loss. Sarcoidosis of the lungs and skin was diagnosed about 3 months ago. Computed tomography revealed signs of stage 2 pulmonary sarcoidosis. According to the results of contrast-enhanced magnetic resonance imaging of the brain with contrast in the right temporal, frontal lobes, and in the insular lobe on the left, areas of increased T2flair signal were identified, up to 16 mm of subcortical localization, without signs of true limitation of the diffusion of water molecules. After administration of a contrast agent, leptomeningeal contrast was noted in both hemispheres of the brain and cerebellum — a probable manifestation of neuroinfection. CONCLUSION. The presented clinical example confirms a wide range of manifestations of neurosarcoidosis, for effective differential diagnosis of which it is advisable to use instrumental and laboratory diagnostic methods along with a thorough physical and neurological examination and an in-depth study of the patient’s medical history. KEYWORDS: sarcoidosis, neurosacoidosis, central nervous system, differential diagnosis, neuroimaging, autoimmune diseases