Abstract
The nervous system is affected in 10% of patients with sarcoidosis. However, neurological disturbances are rarely the first manifestation of the disease. We report a 36-year-old woman presenting with partial seizures that generalized secondarily. Magnetic resonance showed a left parietal cortical-subcortical lesion with a minimal mass effect, moderate vasogenic edema and intense enhancement with intravenous contrast. A magnetic resonance spectroscopy disclosed a low aggressiveness profile, compatible with an inflammatory lesion. Angiotensin converting enzyme levels were normal. The lesion was excised and the pathological study showed the presence of granulomas with dubious necrosis. The patient was treated with antituberculous drugs. One year later, the lesion had grown and a thorax CT scan showed numerous mediastinal and hilar lymphadenopathies. A new determination of angiotensin converting enzyme disclosed elevated levels and the biopsy of mediastinal lymph nodes confirmed the presence of sarcoidosis.
Highlights
The nervous system is affected in 10% of patients with sarcoidosis
We report a 36-year-old woman presenting with partial seizures that generalized secondarily
El estudio de espectroscopia resonancia magnética (RM) demuestra niveles de colina discretamente elevados, con una relación colina/creatina (Cho/Cr) inferior a 2, que junto con la mínima disminución del N-acetil-aspartato sugieren una lesión de baja agresividad, probablemente de tipo inflamatorioinfeccioso
Summary
The nervous system is affected in 10% of patients with sarcoidosis. The lesion was excised and the pathological study showed the presence of granulomas with dubious necrosis. The lesion had grown and a thorax CT scan showed numerous mediastinal and hilar lymphadenopathies. A new determination of angiotensin converting enzyme disclosed elevated levels and the biopsy of mediastinal lymph nodes confirmed the presence of sarcoidosis. Ccorrespondência a: Cristina Lidia Fernández-Rey, C/ Montes del Sueve, 5, 1oF, Oviedo, Asturias, España. El compromiso neurológico como forma de presentación de la sarcoidosis en ausencia de enfermedad sistémica constituye una rareza. Una evaluación global de los hallazgos radiológicos, incluyendo la espectroscopia RM, junto con el contexto clínico del paciente permite reducir el espectro de diagnósticos diferenciales y sospechar la enfermedad
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