On a remarkable form of rotation in the pith cells of Saururus cernuus

Abstract

<b>OBJECTIVE:</b> To compare the incidence of multiple sclerosis (MS) and neurosarcoidosis (NS) diagnoses among patients with systemic sarcoidosis and subsequent neurologic symptoms. <b>BACKGROUND:</b> For sarcoidosis patients who develop neurologic symptoms, accurate diagnosis may be confounded and biased toward neurosarcoidosis. While NS is a reasonable element of differential diagnosis in these cases, other concurrent neurologic conditions such as multiple sclerosis may occur independently. <b>DESIGN/METHODS:</b> We retrospectively examined records of 302 patients referred to the Neurosarcoidosis and MS clinics at Johns Hopkins Hospital between 2000 and 2011. These patients were referred for neurologic complaints suspected to be related to sarcoidosis. We categorized the patients based on the presence or absence of systemic sarcoidosis, central and peripheral neurologic symptoms, and final diagnosis. <b>RESULTS:</b> Of the 302 patients referred, 132 were ultimately diagnosed with NS (with degrees of confidence: possible, probable, or definite). However, 26 patients with prior sarcoidosis were found to have concurrent CNS disease that was not neurosarcoidosis. Among these 26 patients, six had MS as determined by clinical and MRI features. These six MS cases represented 4.8% of the patients with neurologic complaints following previously diagnosed systemic sarcoidosis. Of the remaining patients with systemic sarcoidosis, 22 had peripheral neuropathy and 77 did not have neurologic dysfunction. Forty-five patients had evidence of CNS inflammation without systemic symptoms or other confirmed diagnoses. <b>CONCLUSIONS:</b> A previous diagnosis of systemic sarcoidosis does not necessarily imply that subsequent CNS disease is neurosarcoidosis. Multiple sclerosis and other neurologic conditions can occasionally occur after or simultaneously with systemic sarcoidosis. Accurate diagnosis is essential as treatment and management options differ for these conditions. <b>Disclosure:</b> Dr. Kimbrough has nothing to disclose. Dr. Reyes-Mantilla has nothing to disclose. Dr. Jimenez Arango has nothing to disclose. Dr. Pardo-Villamizar has nothing to disclose.