Neurosarcoidosis: An Illustrative Case and Review of Perioperative Considerations

Vivek Arora, Srilatha Mallu

Department of Anesthesiology, Henry Ford Hospital. W. Grand Blvd, Detroit MI, USA.

DOI: 10.4236/ojanes.2012.24038                

Abstract

Sarcoidosis is a multisystem inflammatory granulomatous disease of unknown etiology. Neurosarcoidosis (NS) is a rare but potentially devastating manifestation of sarcoidosis, with a prevalence of approximately 5% in patients with systemic sarcoidosis. Due to the possible involvement of any part of the nervous system, a myriad of neurological manifestations can occur. Clinical features resulting from involvement of the hypothalmo-pituitary axis and cranial nerves, in particular, cranial nerve VII are the more common presentations of this condition. Medical therapy with corticosteroids is the mainstay of treatment and providing tissue for diagnosis remains the principal indication for surgery. Therapeutically, neurosurgery is indicated only for life-threatening complications. We describe the clinical case of a patient with fatally progressive NS who had multiple anesthetic exposures. This case highlights the perioperative considerations of NS and its anesthetic implications.

Keywords

Neurosarcoidosis; Sarcoidosis; Granuloma; Perioperative Considerations

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	B. A. Rybicki and M. C. Iannuzzi, “Epidemiology of Sarcoidosis: Recent Advances and Future Prospects,” Seminars in Respiratory and Critical Care Medicine, Vol. 28, No. 1, 2007, pp. 22-35. doi:10.1055/s-2007-970331
[2]	R. K. Allen, R. E. Sellars and P. A. Sandstrom, “A Prospective Study of 32 Patients with Neurosarcoidosis,” Sarcoidosis, Vasculitis and Diffuse Lung Diseases, Vol. 20, No. 2, 2003, pp. 118-125.
[3]	V. Terushkin, B. J. Stern, M. A. Judson, M. Hagiwara, B. Pramanik, M. Sanchez, et al., “Neurosarcoidosis: Presentations and Management,” Neurologist, Vol. 16, No. 1, 2010, pp. 2-15. doi:10.1097/NRL.0b013e3181c92a72
[4]	A. V. Patel, D. E. Stickler and W. R. Tyor, “Neurosarcoidosis,” Current Treatment Options in Neurology, Vol. 9, No. 3, 2007, pp. 161-168. doi:10.1007/BF02938405
[5]	L. Ayala, D. B. Barber, M. R. Lomba and A. C. Able, “Intramedullary Sarcoidosis Presenting as Incomplete Paraplegia: Case Report and Literature Review,” Journal of Spinal Cord Medicine, Vol. 23, No. 2, 2000, pp. 96-99.
[6]	D. A. Nowak and D. C. Widenka, “Neurosarcoidosis: A Review of Its Intracranial Manifestation,” Journal of Neurology, Vol. 248, No. 5, 2001, pp. 363-372. doi:10.1007/s004150170175
[7]	E. E. Lower and K. L. Weiss, “Neurosarcoidosis,” Clinics in Chest Medicine, Vol. 29, No. 3, 2008, pp. 475-492. doi:10.1016/j.ccm.2008.03.016
[8]	I. B. Colvin, “Audiovestibular Manifestations of Sarcoidosis: A Review of the Literature,” Laryngoscope, Vol. 116, No. 1, 2006, pp. 75-82. doi:10.1097/01.mlg.0000184580.52723.9f
[9]	R. W. Byard, N. Manton and M. Tsokos, “Sarcoidosis and Mechanisms of Unexpected Death,” Journal of Forensic Sciences, Vol. 53, No. 2, 2008, pp. 460-464. doi:10.1111/j.1556-4029.2008.00662.x
[10]	S. Saleh, C. Saw, K. Marzouk and O. Sharma, “Sarcoidosis of the Spinal Cord: Literature Review and Report of Eight Cases,” Journal of the National Medical Association, Vol. 98, No. 6, 2006, pp. 965-976.
[11]	K. Oe, M. Doita, H. Miyamoto, F. Kanda, M. Kurosaka and M. Sumi, “Is Extensive Cervical Laminoplasty an Effective Treatment for Spinal Cord Sarcoidosis Combined with Cervical Spondylosis?” European Spine Journal, Vol. 18, No. 4, 2009, pp. 570-576. doi:10.1007/s00586-009-0891-2
[12]	G. Galassi, M. Gibertoni, A Mancini, R. Nemni, G. Volpi, E. Merelli and G. Vacca, “Sarcoidosis of the Peripheral nerve: Clinical, Electrophysiological and Histological Study of Two Cases,” European Neurology, Vol. 23, No. 6, 1984, pp. 459-465. doi:10.1159/000115728
[13]	T. F. Scott, K. Yandora, A. Valeri, C. Chieffe and C. Schramke, “Aggressive Therapy for Neurosarcoidosis: Long-Term Follow-Up of 48 Treated Patients,” Archives of Neurology, Vol. 64, No. 5, 2007, pp. 691-696. doi:10.1001/archneur.64.5.691
[14]	J. P. Zajicek, N. J. Scolding, O. Foster, M. Rovaris, J. Evanson, I. F. Moseley, J. W. Scadding, E. J. Thompson, V. Chamoun, D. H. Miller, W. I. McDonald and D. Mitchell, “Central Nervous System Sarcoidosis: Diagnosis and Management,” Quarterly Journal of Medicine, Vol. 92, No. 2, 1999, pp. 103-117. doi:10.1093/qjmed/92.2.103
[15]	H. Akhondi, S. Barochia, B. Holmstrom and M. J. Williams, “Hydrocephalus as a Presenting Manifestation of neurosarcoidosis,” Southern Medical Journal, Vol. 96, No. 4, 2003, pp. 403-406. doi:10.1097/01.SMJ.0000056648.43258.C0
[16]	L. R Robinson, R. Brownsberger and G. Raghu, “Respiratory Failure and Hypoventilation Secondary to Neurosarcoidosis,” American Journal of Respiratory and Critical Care Medicine, Vol. 157, No. 4, 1998, pp. 13161318.
[17]	S. L. Yong, P. Marik, M. Esposito and P. Coulthard, “Supplemental Perioperative Steroids for Surgical Patients with Adrenal Insufficiency,” Cochrane Database of Systematic Reviews, 2009, Article ID: CD005367.
[18]	F. Fery, L. Plat, P. van de Borne, E. Cogan and J. Mockel, “Impaired Counterregulation of Glucose in a Patient with Hypothalamic Sarcoidosis,” New England Journal of Medicine, Vol. 340, No. 11, 1999, pp. 852-856. doi:10.1056/NEJM199903183401105
[19]	M. Jefferson, “Sarcoidosis of the Nervous System,” Brain, Vol. 80, No. 4, 1957, pp. 540-556. doi:10.1093/brain/80.4.540
[20]	A. Richard, F. Girard, D. C. Girard, D. Boudreault, P. Chouinard, R. Moumdjian, B A. outhilier, M. Ruel, J. Couture and F. Varin, “Cisatracurium-Induced Neuromuscular Blockade Is Affected by Chronic Phenytoin or Carbamazepine Treatment in Neurosurgical Patients,” Anesthesia & Analgesia, Vol. 100, No. 2, 2005, pp. 538544. doi:10.1213/01.ANE.0000143333.84988.50
[21]	M. M. Jamal, A. M. Cilursu and E. L. Hoffman, “Sarcoidosis Presenting as Acute Myositis. Report and Review of the Literature,” Journal of Rheumatology, Vol. 15, No. 12, 1988, pp. 1868-1871.