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MORNING REPORT

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MORNING REPORT Katie Doktor, PGY-2 July 13, 2010 Pt is a 30yoF P/w new-onset R sided weakness, numbness and heaviness x2d PMHx Sarcoidosis, dx d 98 Depression ... – PowerPoint PPT presentation

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Title: MORNING REPORT


1
MORNING REPORT
  • Katie Doktor, PGY-2
  • July 13, 2010

2
Pt is a 30yoF
  • P/w new-onset R sided weakness, numbness and
    heaviness x2d
  • started in foot and gradually spread
    cephallicaly to ear
  • only on lateral right side

3
PMHx
  • Sarcoidosis, dxd 98
  • Depression
  • Allergies sulfa drugs
  • Social Hx () tobacco, lt1pk/d

4
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5
MRI Brain
  • Persistent abnormality in the L hemisphere, just
    posterolateral to the 4th ventricle, which has
    markedly decreased since the prior study.
  • Some persistent abnormality in the L cerebellar
    peduncle, which has markedly decreased since the
    prior study.

6
Neurosarcoidosis
  • Occurs in less than 5 of pts w/sarcoid
  • Course Can be monophasic, relapsing-remitting or
    progressive dz punctuated by episodic
    deteriorations
  • 50 of pts w/neurosarcoid p/w neuro Sx at time of
    initial sarcoidosis dx

7
Neurosarcoidosis common syndromes
  • Cranial nerve dysfunction
  • Parenchymal lesions
  • Encephalopathy
  • Meningeal disease
  • Peripheral neuropathy
  • Muscle weakness

8
Neurosarcoidosis differential Dx
  • Lymes disease, idiopathic Bells Palsy, optic
    neuropathy assocd w/MS, TB carcinomatous or
    lympomatous meningitis
  • Astrocytoma or other primary metastatic brain
    tumors, MS
  • Meningitis caused by viral infxn (HIV), TB or
    syphilis.
  • Toxin exposure, metabolic abnl or inflamm d/o
    causing peripheral neuropathy

9
Presentations
10
Clinical Evaluation
  • Examine for evidence of extraneural disease
  • Ophthalmologic examination
  • Endoscopic nasal and sinus exam
  • CXR or CT chest
  • ACE may not be elevated in neurosarcoid
  • Neurodiagnosis tests
  • contrast-enhanced MRI
  • Lumbar puncture elevated opening pressure,
    Tprotein up to 250, mononuclear cell pleocytosis,
    glucose low/nml, elevated IgG index, oligoclonal
    bands

11
(No Transcript)
12
Neurosarcoidosis Tx
  • Corticosteroids
  • Dose/duration determined by dz severity and
    response to therapy
  • Alternatives
  • Azathioprine, methotrexate, mycophenolate
    mofetil, cyclophosphamide, cyclosporine,
    chloramibucil, infliximab, hydroxychloroquine,
    pentoxifylline, thalidomide
  • Other Surgery, Radiation

13
Last episode
  • LP- clear, colorless, Tprotein 110, WBC 3, RBC
    183, alb 60.3, IgG 18.2, Glucose 50, IgG/alb
    30.2, () oligoclonal bands
  • ACE 37 (nml 9-67)
  • ACE in CSF 7 (nml lt15)
  • ANA positive
  • ESR 20

14
This time
  • RF neg
  • C3
  • C4
  • ESR 13
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