MRIにて中脳水道病変を認めた神経サルコイドーシスの一例

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  • A case of neurosarcoidosis with periaquedual abnormal signal on MRI

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Right recurrent laryngeal nerve palsy and uveitis developed in a 31-year-old woman, for which the diagnosis of sarcoidosis was made clinically. Uveitis subsequently exacerbated and taste abnormality as well as unpleasant sensation at the right eye and right oral angle and right facial palsy occurred. On admission, she showed bilateral iritis and eye ground angitis, and neurological examination revealed anisocoria, slow light reflex of the left eye, peripheral right side facial palsy, right hypogeusia of the tongue, and positive finding for Chaddock reflex on the right side. Serum ACE level was within the normal range (23.4U/l). Cerebrospinal fluid test showed a slight increase in cell numbers and protein level. Chest X-ray and CT disclosed bilateral hilar lymphadenopathy. Gallium scintigram showed an accumulation of the tracer in the superior mediastinum. FLAIR (Fluid attenuated inversion recovery) MRI of the head revealed a high-signaled region around the aqueduct of the cerebrum, which was enhanced by gadolinium. Based on these findings and the course of illness, the patient was diagnosed as having neurosarcoidosis. The symptoms were relieved by administration of prednisolone, and the enhancement by gadolinium around the aqueduct of the cerebrum disappeared.

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