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Washington University Experience | MISCELLANEOUS | Neurosarcoid - no PNS | 10A0 Case 10 History
Case 10 History ---- The patient was a 53 yo male with history of hypertension, neurosarcoidosis s/p diagnostic craniotomy resulted in the findings of non-necrotizing granulomatous inflammation with complication of panhypopituitarism in 1984. Although non-necrotizing inflammation can be caused by a variety of disease processes, the long course of illness in this patient as well as negative AFB and GMS stains rule out the possibility of common fungal and mycobacterial infections. Eighteen years later he was admitted for a several month history of mental status changes and poor intake. Over several months, his mental status had worsened and his speech was incoherent. Neurologically, he was blind and deaf in right ear with hearing loss in left side, developed a seizure disorder and had difficulty walking. CT demonstrated hypoattenuation in left parietal/occipital region and right subinsular cortex, ventricular enlargement on left side, post-craniotomy changes on right frontoparietal region and cerebellar atrophy. He had witnessed aspiration and subsequent cardiorespiratory arrest requiring chest compressions. He subsequently developed ARDS, hypotensive shock, and sepsis resulting in episodes of pulseless ventricular tachycardia. Treatment was withdrawn and he expired.
