Artikel
Neuro-ophthalmologic initial presentation of sarcoidosis
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Autoren
Veröffentlicht: | 22. September 2004 |
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Gliederung
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Objective
To describe different forms of neuro-ophthalmologic onset in sarcoidosis: clinical signs, meaning of diagnosis, treatment and evolution.
Results
13 patients with neuro-ophthalmologic initial onset of sarcoidosis have consulted three neuro-ophthalmologic consultations between 1997 and 2003. There were 10 women and 3 men, with a mean age of 32 years. 6 patients suffered from diplopia, 9 patients had involvement of the anterior visual pathway, with 2 patients who had both. In 3 cases, the cavernous sinus was involved with 2 cases with V and VI cranial nerves pareses, and 1 case with III, V and VI cranial nerves pareses. The three other patients with diplopia had meningo-radiculitis. Concerning the visual pathway, the infiltration concerned the optic nerve in 2 cases, the chiasmal in 2 cases and 3 patients had papilloedema secondary to intracranial hypertension. The dosage of the angiotensin-converting enzyme was performed in 9 patients and elevated in only 4 cases. 9 patients underwent lumbar punctures, 5 had a cerebrospinal fluid protein elevated with 3 cases of lymphocytic pleiocytosis. 7 patients had mediastinal adenopathies on chest CT scan among the 11 performed.
11 patients had a histological proof of sarcoidosis. The two other patients had enough clinical evidence to support this diagnosis (one had a negative biopsy). All of them were treated with systemic corticosteroids. The diplopia was improved for the 6 patients without relapse. Concerning the 6 patients with optic nerve or chiasmal infiltration, one wasn't improved, 2 had a partial improvement, and 3 had a completed recovery. 2 of these patients relapsed.
Conclusions
Diplopia and anterior visual pathway abnormalities can be initial onset of sarcoidosis and this diagnosis must stay in mind in front of these usual signs in a neuro-ophthalmologic consultation. Complementary exams are needed to confirm this diagnosis at best with a histological proof. The treatment is corticosteroid with generally a great improvement even if relapse can occur.