DOI QR코드

DOI QR Code

Moyamoya-Like Vasculopathy in Neurosarcoidosis

  • Ko, Jun-Kyeung (Department of Neurosurgery, School of Medicine, Pusan National University) ;
  • Lee, Sang-Weon (Department of Neurosurgery, School of Medicine, Pusan National University) ;
  • Choi, Chang-Hwa (Department of Neurosurgery, School of Medicine, Pusan National University)
  • Published : 2009.01.28

Abstract

A 31-year-old man presented with dull headache and memory disturbance lasting for one week. Computed tomographic scans revealed acute hydrocephalus. The cerebrospinal fluid contained 53 leukocytes/$mm^3$, with a mononuclear preponderance and no erythrocytes. Magnetic resonance imaging revealed hydrocephalus and leptomeningeal enhancement. Magnetic resonance angiography and digital subtraction angiography showed supraclinoid occlusion of the right internal carotid artery, which resembled unilateral moyamoya disease. Neuroendoscopic biopsy of a lesion in the septum pellucidum revealed noncaseating granulomas, which was consistent with sarcoidosis. The patient was successfully managed with intravenous methylprednisolone and ventriculoperitoneal shunting. To our knowledge, this is the first case of moyamoya-like vasculopathy associated with neurosarcoidosis.

Keywords

References

  1. Benzagmout M, Boujraf S, G$\acute{o}$ngora-Rivera F, Bresson D, Van- Effenterre R : Neurosarcoidosis which manifested as acute hydrocephalus : diagnosis and treatment. Intern Med 46 : 1601-1604, 2007 https://doi.org/10.2169/internalmedicine.46.0126
  2. Brisman JL, Hinduja A, McKinney JS, Gerhardstein B : Successful emergent angioplasty of neurosarcoid vasculitis presenting with strokes. Surg Neurol 66 : 402-404, 2006 https://doi.org/10.1016/j.surneu.2006.02.048
  3. Brown MM, Thompson AJ, Wedzicha JA, Swash M : Sarcoidosis presenting with stroke. Stroke 20 : 400-405, 1989 https://doi.org/10.1161/01.STR.20.3.400
  4. Das SK, Sinha I, Kundu TN, Sanyal K, Santosh V, Shankar SK : Two cases of neurosarcoidosis presenting as peripheral neuropathy and stroke in young. J Assoc Physicians India 46 : 479-481, 1998
  5. Duffey P, Bates D : Transient focal neurological deficit in sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis 14 : 171-172, 1997
  6. Hamada H, Hayashi N, Kurimoto M, Umemura K, Hirashima Y, Endo S : Isolated third and fourth ventricles associated with neurosarcoidosis successfully treated by neuroendoscopy--case report. Neurol Med Chir (Tokyo) 44 : 435-443, 2004 https://doi.org/10.2176/nmc.44.435
  7. Hodge MH, Williams RL, Fukui MB : Neurosarcoidosis presenting as acute infarction on diffusion-weighted MR imaging : summary of radiologic findings. AJNR Am J Neuroradiol 28 : 84-86, 2007
  8. Johns CJ, Michele TM : The clinical management of sarcoidosis : a 50-year experience at the Johns Hopkins Hospital. Medicine (Baltimore) 78 : 65-111, 1999 https://doi.org/10.1097/00005792-199903000-00001
  9. Kim JS, No YJ : Moyamoya-like vascular abnormality in pulmonary sarcoidosis. Cerebrovasc Dis 22 : 71-73, 2006 https://doi.org/10.1159/000092924
  10. Smith JK, Matheus MG, Castillo M : Imaging manifestations of neurosarcoidosis. AJR Am J Roentgenol 182 : 289-295, 2004 https://doi.org/10.2214/ajr.182.2.1820289
  11. Stern BJ, Krumholz A, Johns C, Scott P, Nissim J : Sarcoidosis and its neurological manifestations. Arch Neurol 42 : 909-917, 1985 https://doi.org/10.1001/archneur.1985.04060080095022
  12. Takenaka K, Ito M, Kumagai M, Yamakawa H, Sugimoto Y, Yamakawa H, et al : Moyamoya disease associated with pulmonary sarcoidosis--case report. Neurol Med Chir (Tokyo) 38 : 566-568, 1998 https://doi.org/10.2176/nmc.38.566

Cited by

  1. A Case of Possible Neurosarcoidosis Presenting as Intractable Headache and Panhypopituitarism vol.2013, pp.None, 2009, https://doi.org/10.1155/2013/816236
  2. Cerebrovascular Manifestations of Neurosarcoidosis: An Underrecognized Aspect of the Imaging Spectrum vol.39, pp.7, 2018, https://doi.org/10.3174/ajnr.a5492
  3. Neurosarcoidosis: clinical manifestations, investigation and treatment vol.20, pp.3, 2009, https://doi.org/10.1136/practneurol-2019-002349
  4. Letter to the Editor Regarding “A Rare Case of Postinfectious Moyamoya Syndrome: Case Report and Review of the Literature” vol.146, pp.None, 2009, https://doi.org/10.1016/j.wneu.2020.10.029