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• Vol.58 No.7
• CLINICA NEUROL, 58: 445−450, 2018
• Vol.58 No.7 contents

Case Report

A case of neurosarcoidosis with recurrent brainstem infarction, obstructive hydrocephalus and brainstem atrophy

Hiroko Kimura, M.D.¹⁾, Jun Takeuchi, M.D.¹⁾, Tsuyoshi Tsutada, M.D.¹⁾, Kenji Ohata, M.D.²⁾, Masahiko Osawa, M.D.³⁾ and Yoshiaki Itoh, M.D.¹⁾

¹⁾Department of Neurology, Osaka City University
²⁾Department of Neurosurgery, Osaka City University
³⁾Department of Pathology, Osaka City University Graduate School of Medicine

We report the case of a 42-year-old female with neurosarcoidosis who was hospitalized in year 2017 for gait disturbance. In 2011, she suddenly had vertigo that lasted for a few days. In 2013, she noticed left hemiplegia. A brain MRI revealed an acute infarction on the right side of the upper pons extending longitudinally from the ventral surface. In 2017, she again had left lower limb paralysis. A Brain MRI showed another infarction on the right side of the mid-pons. Hydrocephalus and brainstem atrophy were also noted. The patient was referred to our hospital. Upon neurological examination, she presented with down beat nystagmus, muscle weakness on the left side, and a broad-based spastic gait. CSF findings included an increased number of cells and protein levels with decreased glucose levels. A contrastenhanced MRI revealed basilar meningitis causing hydrocephalus. A contrast CT scan revealed inguinal lymph node swelling, and scintigram found gallium accumulation. We diagnosed sarcoidosis via a lymph node biopsy. We speculate that chronic basilar meningitis obstructed the patient's branching penetrating arteries inducing infarction together with obstruction of the spinal fluid flow causing hydrocephalus and cerebral atrophy.
Full Text of this Article in Japanese PDF (915K)

(CLINICA NEUROL, 58: 445−450, 2018)
key words: neurosarcoidosis, meningitis, brainstem infarction, hydrocephalus

(Received: 6-Mar-18)