Neurosarcoidosis in a public safety net hospital: a study of 82 cases. Sarcoidosis Vasc Diffuse Lung Dis 2019;36(1):25-32
Date
01/01/2019Pubmed ID
32476933Pubmed Central ID
PMC7247114DOI
10.36141/svdld.v36i1.7106Abstract
OBJECTIVE: To characterize clinical presentation, laboratory and imaging data, and treatment outcomes for neurosarcoidosis in an urban safety net hospital.
METHODS: The research database of Cook County Health and Hospitals system was queried for all cases of sarcoidosis from 2006 to 2013. These cases plus those identified through a survey of neurology faculty were reviewed and flagged if suspected to be neurosarcoidosis. Data were extracted in a standardized fashion, upon review by two experienced neurologists; patients were classified as definite, probable or possible neurosarcoidosis. Disagreements on classification were resolved by consensus conference.
RESULTS: 1706 cases of sarcoidosis were identified, with 82 (4.8%) classified as neurosarcoidosis. The cohort was predominantly African American (89%). Six were classified as definite, 34 as probable, and 42 as possible neurosarcoidosis. Neurosarcoidosis was the presenting symptom of sarcoidosis in 74% of cases. The most common presenting phenotype was myelopathy (21.7%), followed by optic nerve/chiasm involvement (16.0%) and epilepsy (11.3%). The facial nerve was involved in only 2% of cases. Chest x-ray showed abnormalities of sarcoidosis in 43.3% of cases, while chest CT did so in 78.6%. Corticosteroids were the initial treatment in 91% of cases, and outcomes were good in 53% of cases.
CONCLUSION: Neurosarcoidosis remains a challenging diagnosis with the majority of patients without a previous diagnosis of systemic sarcoidosis. Chest imaging was supportive of the diagnosis in a majority of patients. Our cohort differs from others in the literature due to a low prevalence of facial nerve involvement. Prospective registry studies are needed.
Author List
Dorman J, Warrior L, Pandya V, Sun Y, Ninan J, Trick W, Zhang H, Ouyang BAuthor
Vishal B. Pandya MD Assistant Professor in the Neurology department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
Adrenal Cortex HormonesAdult
Aged
Biopsy
Central Nervous System Diseases
Databases, Factual
Female
Hospitals, Public
Humans
Illinois
Magnetic Resonance Imaging
Male
Middle Aged
Phenotype
Predictive Value of Tests
Prognosis
Radiography, Thoracic
Retrospective Studies
Safety-net Providers
Sarcoidosis
Young Adult
