% 0期刊文章%一个贾斯汀Abbatemarco伊丽莎白Spurgeon % %玛丽威利斯理查德·Prayson % % T神经耀斑多病灶的扩散限制:中风,炎症,或都有?(P1.349) % D J神经病学20首页18% % P P1.349 % V 90% N 15补充% X目的:向患者神经神经迅速衰退,大量leptomeningeal增强,多病灶的扩散限制的设定药物停药。背景:结节病是一种多系统肉芽肿疾病与神经系统参与大约5%的病例。神经症状的范围从视神经炎和其他颅神经病变脑积水、脊髓炎和小纤维神经病。Leptomeningeal增强经常描述但报道类似中风的症状或出现缺血的MRI是罕见的。设计/方法:37岁的非裔美国人在2015年最初出现神经症状。他最初的核磁共振显示几个,软脑膜显影并且温和提高实质病变。结节病的诊断成立后广泛的评价对其他原因和淋巴结活检显示noncaseating肉芽肿。他的临床和影像学稳定在甲氨蝶呤。他停止药物治疗后随访预约和随后承认改变精神状态。他迅速拒绝一个昏迷的状态。MRI大脑显示,两国额限制扩散,顶叶、颞、枕叶、中脑、脑桥、小脑半球,和双边花托。 Extensive leptomeningeal enhancement was noted. A cerebral angiogram showed no vascular abnormalities. A right parietal lobe brain biopsy was obtained showed a nonnecrotizing granuloma and areas of infarction and necrosis with inflammatory cells including macrophages. He was restarted on an immunosuppressive regimen and improved slowly over the next few months.Results: Not ApplicableConclusions: This is the first case to report both extensive leptomeningeal disease and multiple areas of infarct. Mechanisms of stroke have not been clearly defined in neurosarcoidosis. Possibilities include granulomatous invasion of vessel walls causing a small vessel vasculitis, embolic phenomena due to cardiac sarcoidosis (though not identified in this patient), or hypercoagulable state.Disclosure: Dr. Spurgeon has nothing to disclose. Dr. Abbatemarco has nothing to disclose. Dr. Prayson has nothing to disclose. Dr. Willis has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Biogen, Genzyme. %U

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