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Case No. 667
2023-09-01~2023-09-30
출제자 : 박미나
Hit : 451
| Period | 2023-09-01~2023-09-30 |
|---|---|
| Diagnosis | Neurosarcoidosis |
| Gender |
|
| Age | 45 |
| Clinical information | 45세 남환 진행되는 dysphagia및 facial palsy로 내원. 진단은? |
| Discussion | Background: Sarcoidosis is a chronic, multisystemic, idiopathic disease characterized by noncaseating granulomas. Women have a 3x and 2x higher risk, respectively. It can affect various organs, including the lungs, lymphatic system, eyes, skin, liver, spleen, salivary glands, heart, nervous system, muscles, and bones. Clinical neurologic symptoms occur in about 5% of patients. Clinical Presentation: Neurosarcoidosis can involve any part of the CNS and presents with nonspecific symptoms like headache, cranial nerve deficits, weakness, seizures, diabetes insipidus, hypopituitarism, encephalopathy, or myelopathy. Key Diagnostic Feature: Leptomeningeal involvement, nodular and/or diffuse, with preferential involvement of basal cisterns; may spread along perivascular spaces Cranial nerve thickening and enhancement (most common: nerve VII, II, and V) Nonenhancing T2-hyperintense brain parenchymal lesion (which can mimic demyelinating disorders) Enhancing brain parenchymal lesion (mostly affects hypothalamus, brain stem, cerebral and cerebellar hemispheres) Dural involvement including thickening or mass (main differential: meningioma) Symptoms usually improve after corticosteroid treatment. |
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Correct Answer
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