ABSTRACT
To assess central nervous system (CNS) involvement with normal CNS examination, multimodality evoked potentials were obtained in 25 patients with confirmed multisystem sarcoidosis. Twelve patients had abnormal evoked potentials: brainstem auditory evoked potentials (BAEP) were abnormal in 5, median nerve somatosensory evoked potentials (SEP) were abnormal in 4, and visual evoked potentials (VEP) were abnormal in 6 patients. Contrast-enhanced magnetic resonance imaging (MRI) of the brain in two patients with abnormal evoked potentials revealed no supportive structural lesions. Multimodality evoked potentials can detect subclinical neurosarcoidosis and are an important adjunct to neuroradiology in the diagnosis of neurosarcoidosis.
Subject(s)
Brain/physiopathology , Evoked Potentials, Auditory/physiology , Evoked Potentials, Somatosensory/physiology , Evoked Potentials, Visual/physiology , Sarcoidosis/physiopathology , Adult , Aged , Brain/pathology , Brain Diseases/diagnosis , Brain Diseases/etiology , Brain Diseases/physiopathology , Female , Follow-Up Studies , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Sarcoidosis/complications , Sarcoidosis/diagnosisABSTRACT
Central nervous system (CNS) involvement in Sarcoidosis poses a difficult diagnostic problem for the clinician. Neurologic involvement may occur long before the onset of symptoms. Contrast enhanced computerized tomography does not always reveal parenchymal and meningeal involvement. Recently gadolinium enhanced Magnetic Resonance Imaging has shown increased sensitivity in detecting CNS involvement. These findings however are not specific for sarcoidosis and one must consider appropriate clinical circumstances in arriving at the diagnosis.
Subject(s)
Brain Diseases/diagnosis , Magnetic Resonance Imaging , Sarcoidosis/diagnosis , HumansABSTRACT
Pneumocystis carinii is the most frequent manifestation of the acquired immune deficiency syndrome. Typical histologic findings include foamy, acellular eosinophilic intra-alveolar exudate in which the cysts of the organisms are readily demonstrated with silver stains. Granuloma formation is rare. Only nine such cases have been described in the English literature. We reviewed 400 transbronchial biopsies done in patients suspected of having pneumocystis pneumonia at our institution between the period of 1987-1990. Of the 320 biopsy specimens with Pneumocystis carinii identified, 17 cases had granulomatous inflammation with or without Pneumocystis carinii present. All cultures for tuberculosis and fungi were negative during initial admission and follow up in fifteen cases. One was later found to have tuberculosis and another about 6 months later histoplasmosis, when rebronchoscoped for suspicion of recurrent Pneumocystis infection. None of our patients had clinical evidence for sarcoidosis or hypersensitivity pneumonitis. We believe that granulomatous pneumonitis should be included in the list of pulmonary complications associated with Pneumocystis carinii pneumonia. Clinical significance and immunologic nature remains unexplained.
