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High-signal periventricular lesions in patients with sarcoidosis: neurosarcoidosis or multiple sclerosis?
A S Smith1, D M Meisler, M A Weinstein
1Division of Radiology, Cleveland Metropolitan General Hospital, Cleveland, OH 44109.
Abstract:
The vast majority of periventricular abnormalities visualized with MR imaging in patients less than 50 years old represents multiple sclerosis (MS) lesions. There are many other causes of periventricular lesions, most of which can be differentiated from MS on the basis of history and physical or MR findings. Five cases of biopsy- or Kveim test-proved sarcoidosis with MR findings consistent with MS are reported. Each of these patients, diagnosed as having sarcoidosis, had symptoms identical to those seen in MS. Although these patients have not had histologic characterization of the intraparenchymal lesions seen on MR, they illustrate the difficulty of differentiating sarcoidosis with CNS involvement from MS in some patients on the basis of clinical, radiographic, electrodiagnostic, or CSF testing. This series contributes to a growing body of evidence that neurosarcoidosis probably should be included in the differential diagnosis of isolated periventricular lesions in patients less than 50 years old.
Insights
Multiple sclerosis (MS) is often mistaken for neurosarcoidosis in patients under 50. This study highlights the diagnostic challenges, suggesting neurosarcoidosis should be considered for periventricular lesions.
Area of Science:
- Neurology
- Radiology
- Immunology
Background:
- Periventricular abnormalities on MRI in patients under 50 typically indicate multiple sclerosis (MS).
- Differentiating MS from other causes of periventricular lesions relies on clinical history, physical examination, and MRI findings.
Observation:
- Five cases of biopsy-proven sarcoidosis presented with MRI findings mimicking MS.
- Patients with neurosarcoidosis exhibited symptoms similar to those of MS.
- Histologic confirmation of intraparenchymal lesions was not performed in these cases.
Findings:
- Sarcoidosis with central nervous system (CNS) involvement can present with periventricular lesions that are difficult to distinguish from MS.
- Clinical, radiographic, electrodiagnostic, and cerebrospinal fluid (CSF) testing may not reliably differentiate between MS and neurosarcoidosis in some instances.
Implications:
- Neurosarcoidosis should be included in the differential diagnosis for isolated periventricular lesions in patients under 50.
- This finding underscores the importance of considering sarcoidosis in the diagnostic workup of unexplained neurological symptoms and periventricular lesions.