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57th Annual Meeting of the German Society for Neuropathology and Neuroanatomy (DGNN)

German Society for Neuropathology and Neuroanatomy

12. - 15.09.2012, Erlangen

57th Annual Meeting of the German Society for Neuropathology and Neuroanatomy (DGNN)

Diagnosis of neurosarcoidosis by FDG PET/CT

Meeting Abstract

  • presenting/speaker Norbert Blumstein - Klinikum Landshut, Nuclear Medicine, Landshut, Germany
  • Reinhold Zimmerman - Klinikum Landshut, Pulmonology, Landshut, Germany
  • Willibald Permanetter - Klinikum Landshut, Pathology, Landshut, Germany
  • Dieter Woischneck - Klinikum Landshut, Landshut, Germany
  • Josef Heckmann - Kliniukm Landshut, Neurology, Landshut, Germany

Deutsche Gesellschaft für Neuropathologie und Neuroanatomie. 57th Annual Meeting of the German Society for Neuropathology and Neuroanatomy (DGNN). Erlangen, 12.-15.09.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. Doc12dgnnPP1.18

DOI: 10.3205/12dgnn036, URN: urn:nbn:de:0183-12dgnn0368

Published: September 11, 2012

© 2012 Blumstein et al.
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Outline

Text

Question: Clinical diagnosis of neurosarcoidosis is often delayed due to its heterogenous manifestations. Spinal cord involvement, radiculopathy, and peripheral neuropathy are rare. We present a patient with .findings of [18F]-fluorodeoxyglucose (F18-FDG) imaging visualizing a neurosarcoidosis.

Case report: A 37-year old woman complained of back pain, distal paraesthesia in all extremities, a feeling of pressure belt-shaped around her abdomen as well as facial palsy, unsteadiness and hearing impairment for weeks. Cerebral and lumbar MRI were found unsuspicious. The first CSF analysis showed a slight lymphocytic pleocytosis with elevated protein level. Initially neuroborreliosis was suspected, and treatment with ceftriaxone was initiated. The .first interpretation of the chest X-ray was judged to be normal. Seeking a tumour was ordered to rule out a paraneoplastic cause of the clinical syndrome. In order to use a very sensitive method for searching a malignant process of unknown origin, a F18-FDG PET/CT was performed. The result provided the cue to sarcoidosis with an increased tracer-uptake in mediastinal lymphnodes and additionally in lumbar spinal ganglia. The diameter of the enlarged lymph nodes amounted between 7.5 and 9 mm. At second glance the X-ray showed a slightly enhanced mediastinum. After suspected diagnosis of neurosarcoidosis was drawn, by following thoracic and abdominal CT-scanning as well as bronchoscopic biopsy a treatment regime with prednisolone was initiated, and symptoms were soon regressive.

Discussion: Our case clearly indicates that diagnosing neurosarcoidosis is often delayed, as the clinical symptoms are not specic and mimicking other neurological diseases such as neuroborreliosis. PET/CT is a superior method to come to a specific diagnosis and to start therapy immediately.