A case of biopsy-proven sarcoid meningoencephalitis presented with hallucination, nominal aphasia and dementia
Type of Spiritual Experience
Neurosarcoidosis is granulomas in various tissues, involving the central nervous system (brain and spinal cord). It can have many manifestations, but abnormalities of the cranial nerves (a group of twelve nerves supplying the head and neck area) are the most common. It may develop acutely, subacutely, and chronically. Approximately 5-10% of people with sarcoidosis of other organs (e.g. lung) develop central nervous system involvement.
Since the researchers did not find the cause of the granulomas, the man is obviously not cured, all that has happened, by giving him immunosuppressants, is that they have suppressed the symptoms and the immune system, thus hastening the illness. The paper did not say when he died.
A description of the experience
Rinsho Shinkeigaku. 1995 Sep;35(9):1008-11.
[A case of biopsy-proven sarcoid meningoencephalitis presented with hallucination, nominal aphasia and dementia].
[Article in Japanese]
Hayashi T1, Onodera J, Nagata T, Mochizuki H, Itoyama Y.
Department of Neurology, Tohoku University School of Medicine.
Here we report a 36-year-old male with sarcoid meningoencephalitis who initially presented with hallucination, nominal aphasia and disturbance of consciousness.
After the onset, his symptoms fluctuated. He had no meningeal signs, and his cranial nerves were normal except for bilateral papapilledema. Muscle power and tone was normal, and there was no gait disturbance. Deep tendon reflexes were slightly exaggerated in lower extremities, but no pathological reflexes were noted. There was no impairment in extrapyramidal system, cerebellar system and sensory system.
The cerebrospinal fluid revealed increased opening pressure, mild lymphocytic pleocytosis, slightly decreased glucose, increased protein to 87mg/dl and increased IgG index to 1.11. Cerebrospinal fluid culture was negative.
Marked meningeal thickening and contrast enhancement was shown by CT and MRI. The meningeal biopsy demonstrated characteristic sarcoid nodules and confirmed the diagnosis of neurosarcoidosis. His manifestations were alleviated by oral administration of corticosteroid.
Since neurosarcoidosis is a disorder treatable with corticosteroid, it is important to consider the possibility of this disorder in mind when a patient is presenting with psychiatric manifestations and chronic meningitis.