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Washington University Experience | MISCELLANEOUS | Neurosarcoid - no PNS | 11A0 Case 11 History
Case 11 History ---- The patient was a 59-year-old white male who initially presented with a picture of declining alertness and short term memory and retching, with striking temporal lobe inflammation (as visualized on MRI scans) suggestive of encephalitis. However, in spite of adequate therapy, he deteriorated and repeat imaging at the time revealed bilateral temporal lobe lesions. This prompted a brain biopsy, which revealed extensive parenchymal (non-caseating) granulomatous inflammation. Extensive evaluation for other infectious causes were negative and a potential diagnosis of neurosarcoidosis was entertained, though a Gallium scan did not show any systemic disease. He also had seizures and was treated with Dilantin in addition to steroids. His amnestic syndrome appeared to slightly improve with steroids though he had unfavorable side effects – thus, alternative medications such as cyclosporine and methotrexate were tried. His cognition and memory progressively declined with worsening seizure control. He had basal meningeal and cranial nerve involvement associated with cerebellar signs, ataxia, nystagmus and diplopia. He then underwent brain irradiation. Follow-up MRI scans showed progression of atrophy, especially in the posterior fossa. He had mood problems requiring medication. He later developed gait and balance problems (causing falls and fractures), neurogenic bladder and hearing loss, causing him to be disabled and requiring increasing assistance and, eventually, debilitation and death.
