Open AccessSarcoidosis with basal ganglial infiltration presenting as Parkinsonism
Author(s) -
Spyridon Papapetropoulos,
Alexandra Guevara,
Mike Georgiou,
Georgia Mitsi,
Carlos Singer,
Sylvia Delgado
Publication year - 2009
Publication title -
bmj case reports
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.231
H-Index - 26
ISSN - 1757-790X
DOI - 10.1136/bcr.07.2008.0569
Subject(s) - medicine , sarcoidosis , fluid attenuated inversion recovery , neurosarcoidosis , brain biopsy , asymptomatic , biopsy , radiology , magnetic resonance imaging , prednisone , lesion , exacerbation , parkinsonism , pathology , surgery , disease
The present report describes the case of a woman with symptoms of Parkinsonism (slow and monotonous speech, left foot dragging and micrographia) that gradually developed over a period of 12 months. She had a 10-month history of untreated, asymptomatic sarcoidosis diagnosed by routine biopsy of an enlarged left supraclavicular lymph node. After her condition deteriorated, a brain MRI showed right basal ganglial areas of haemorrhage with perilesional fast fluid-attenuated inversion-recovery (FLAIR) abnormalities. Right stereotactic frame-based brain parenchymal biopsy of the lesion site revealed reactive central nervous system (CNS) tissue with perivascular chronic inflammation and non-caseating granulomas consistent with definite neurosarcoidosis. The patient was started on a high dose of prednisone with good initial response. When mild progression was noted within the next 12 months azathioprine was added to her treatment. The patient's neurological status has been stable without progression of her Parkinsonian symptomatology.