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Neurology (Expert Forum)
Neurosarcoidosis
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Neurosarcoidosis
by Hollymist, Sep 15, 2000 12:00AM
I was diagnosed with Sarcoidosis in 1989, and originally had lung, cardiac, and skin involvement. I just recently (past 3 months)developed a constant feeling of irritation and pressure in my head, and have had decreased concentration and severe fatigue. When I try to do any type of aerobic exercise my head is literally pounding, and my heart rate goes immediately to 170 or above. I have a resting tachycardia of 100-110. I have struggled to continue working as a nurse for 3 months with these symptoms, but have reached my exhaustion point. My internist did an MRI which shows a pituitary microadenoma without hormone level excesses and a 1 cm pineal cyst. I also can intermittently and internally hear "electrical impulses" coming up the back of my neck into the base of my brain, which I know is something bizarre that I've never heard of before. I have seen an endocrinologist who is referring me to a neurologist whom I will see in October. My internist wrote on my disability papers that I have Sarcoidosis and may never get better or be able to return to work. I am very concerned about this, and wolud appreciate any insight you could provide on these symptoms and what possible diagnostic workup is appropriate. Thank You!
Doctor's Answer
by CCF Neuro[P] MD, RPS, Sep 15, 2000 12:00AM
Dear Hollymist:
Sorry to hear about your condition. I am afraid I will not likely be able to help much. Neurosarcoidosis is very uncommon in general. One usually develops facial neuropathies (cranial nerves) more so than brain problems. Since you have essentially a normal MRI of the brain, the chances of a neurosarcoidosis is unlikely (I can't say for sure because I did not read the film). The microadenoma without hormonal changes is not causing the problems. The 1 cm pineal cyst is also not likely causing your problems (a more common incidental finding). It is possible that the "neuro" finding are due to some MRI negative lesion (unlikely but theoretically possible). I would then suggest a CSF analysis, routine and ACE level, and would also throw in oligo clonal bands, IgG synthesis, and atypical lymphocytes studies. But based on what you have told me, it doesn't sound like neurosarcoidosis.
Sorry, I am not much help.
Sincerely,
CCF Neuro MD
Sorry to hear about your condition. I am afraid I will not likely be able to help much. Neurosarcoidosis is very uncommon in general. One usually develops facial neuropathies (cranial nerves) more so than brain problems. Since you have essentially a normal MRI of the brain, the chances of a neurosarcoidosis is unlikely (I can't say for sure because I did not read the film). The microadenoma without hormonal changes is not causing the problems. The 1 cm pineal cyst is also not likely causing your problems (a more common incidental finding). It is possible that the "neuro" finding are due to some MRI negative lesion (unlikely but theoretically possible). I would then suggest a CSF analysis, routine and ACE level, and would also throw in oligo clonal bands, IgG synthesis, and atypical lymphocytes studies. But based on what you have told me, it doesn't sound like neurosarcoidosis.
Sorry, I am not much help.
Sincerely,
CCF Neuro MD
