Table of Contents
Washington University Experience | MISCELLANEOUS | Neurosarcoid - no PNS | 5A0 Case 5 History
Case 5 History ---- The patient was a 39 year old man with a history of cerebrovascular accident, seizures, and hydrocephalus who was status-post multiple ventriculoperitoneal and ventriculoatrial shunt placements. Additional medical history included systemic sarcoidosis, pulmonary embolism, gastrointestinal bleeding, and pseudomonas urinary tract infection. The patient underwent extensive work-up during multiple hospitalizations to identify a cause to explain his hydrocephalus. The differential diagnoses included neurosarcoid, bacterial meningitis, or meningeal tuberculosis. He was treated empirically with steroids and anti-tuberculosis medicine for possible meningeal tuberculosis as well as a variety of antibiotics. The next day, the patient developed low blood pressure and altered levels of consciousness. The patient's further work-up included an open brain biopsy that showed meningeal fibrosis of unknown etiology. His mental status continued to deteriorate and he suffered multiple seizures and died. Non-necrotizing granulomatous inflammation was identified in the liver, hilar lymph nodes, abdominal lymph nodes and the CNS. The identification of multiple space occupying and coalescent non-necrotizing granulomas associated with the leptomeninges, Damage to the Virchow-Robin spaces involving the hippocampus, brainstem, cerebellum, and spinal cord provides an anatomic explanation for the increased intracranial pressures, and seizures that the patient experienced during life. AFB and GMS stains for acid-fast and fungal organisms were negative.
