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Jiménez-Bonilla, Miguel A. González-Gay, Ignacio Banzo" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Julio F." "apellidos" => "Jiménez-Bonilla" "email" => array:1 [ 0 => "jjimenez@humv.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Miguel A." "apellidos" => "González-Gay" "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] 2 => array:3 [ "nombre" => "Ignacio" "apellidos" => "Banzo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Nuclear Medicine Department, University Hospital Marqués de Valdecilla, University of Cantabria, Molecular Imaging Group – IDIVAL, Santander, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Rheumatology, University Hospital Marqués de Valdecilla, IDIVAL, Santander, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "School of Medicine, University of Cantabria, Santander, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Utilidad de la 18F-FDG-PET/CT en un paciente con neurosarcoidosis" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1898 "Ancho" => 2333 "Tamanyo" => 280360 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Maximum intensity projection of <span class="elsevierStyleSup">18</span>F-FDG PET/CT shows abnormal uptake in the hiliar and mediastinal lymph nodes and parotid glands (A). Selected sagittal fused <span class="elsevierStyleSup">18</span>F-FDG PET/CT (B) image shows hypermetabolism in the spinal cord, especially at the upper and lower ends (arrows). Normal appearance of the spinal cord on MRI (C–E).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Neurosarcoidosis is a rare neuro-inflammatory disorder with protean manifestations which represents a diagnostic challenge. It can show different clinical presentation, from chronic meningitis to myelopathy.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">1</span></a> Their identification in a patient is critical for applying an appropriate treatment in order to decrease the mortality and morbidity and to obtain lower relapse rates. Gadolinium-enhanced MRI is the preferred imaging modality for neurosarcoidosis</p><p id="par0010" class="elsevierStylePara elsevierViewall">We report the case of a 30-year-old woman with an unremarkable past history presented to the hospital with a history of conjunctival hyperemia, photosensitivity and pain in the right eye of four weeks duration. She also complained of pain of both ankles, knees and lumbo-sacral region. She also noticed painful pretibial nodular lesions. A sarcoidosis was suspected. However, a chest radiograph did not show abnormalities. Symptoms worsened over the last two weeks prior to admission since she started to have vertigo and paresthesias in the tongue and in the left side of her face. On admission the physical examination disclosed a left-sided peripheral facial nerve palsy. Spinal and brain MRI were reported as being normal. A treatment with 30<span class="elsevierStyleHsp" style=""></span>mg/day of prednisone was started. However, symptoms did not improve. In addition, and a bilateral uveitis with vitritis was also observed.</p><p id="par0015" class="elsevierStylePara elsevierViewall">An <span class="elsevierStyleSup">18</span>F-FDG PET/CT disclosed abnormal hypermetabolic uptake in the hilar and mediastinal lymph nodes, in both parotid glands and a diffuse uptake throughout the spinal cord, more intense at the upper and lower ends (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Taking into account the clinical data along with the <span class="elsevierStyleSup">18</span>F-FDG PET/CT findings a diagnosis of neurosarcoidosis was considered. Further studies included a lumbar puncture that showed abnormal cerebrospinal fluid consisting of raised protein level and lymphocytic pleocytosis and an increased CD4/CD8 ratio. A parotid gland biopsy confirmed the presence of non-caseating sarcoid granulomas. A treatment consisting of intravenous methyl-prednisolone pulses (500<span class="elsevierStyleHsp" style=""></span>mg/day for three consecutive days) followed by oral prednisone 60<span class="elsevierStyleHsp" style=""></span>mg/day for 3 weeks and then progressive tapering of the prednisone dose, methotrexate (10<span class="elsevierStyleHsp" style=""></span>mg/week/subcutaneously), and intravenous anti-TNF-infliximab (5<span class="elsevierStyleHsp" style=""></span>mg/kg at day 0, at week 2, week 6 and then every 8 weeks) was started. Following this treatment, the patients experienced a progressive improvement of symptoms. At present, 6 months after the diagnosis of sarcoidosis the patient is asymptomatic.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">The present case is of interest because spinal and brain MRI were normal. However, an <span class="elsevierStyleSup">18</span>F-FDG PET/CT assessed the extent of the disease affecting the spinal cord. The diagnosis was confirmed by cerebrospinal fluid analysis. MRI and PET imaging discordance in neurosarcoidosis has been previously reported in some isolated reports.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">2</span></a> Nevertheless, this relevant finding reinforces the useful role of <span class="elsevierStyleSup">18</span>F-FDG PET/CT in difficult cases, because it is able to show the metabolic abnormalities linked to neuroinflammation, specially in the absence of infiltrative spinal cord lesions, which are more suitable to be detected by MRI.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">3</span></a><span class="elsevierStyleSup">18</span>F-FDG PET/CT offers an early metabolic window to investigate a potential neurosarcoidosis.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1898 "Ancho" => 2333 "Tamanyo" => 280360 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Maximum intensity projection of <span class="elsevierStyleSup">18</span>F-FDG PET/CT shows abnormal uptake in the hiliar and mediastinal lymph nodes and parotid glands (A). Selected sagittal fused <span class="elsevierStyleSup">18</span>F-FDG PET/CT (B) image shows hypermetabolism in the spinal cord, especially at the upper and lower ends (arrows). Normal appearance of the spinal cord on MRI (C–E).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib0020" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Many faces of neurosarcoidosis: from chronic meningitis to myelopathy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "D. Fritz" 1 => "M. Voortman" 2 => "D. van de Beek" 3 => "M. Drent" 4 => "M.C. Brouwer" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/MCP.0000000000000401" "Revista" => array:7 [ "tituloSerie" => "Curr Opin Pulm Med" "fecha" => "2017" "volumen" => "23" "paginaInicial" => "439" "paginaFinal" => "446" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28598872" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0140673600035029" "estado" => "S300" "issn" => "01406736" ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0025" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "MRI and PET imaging discordance in neurosarcoidosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.F. Huang" 1 => "A.J. Aksamit" 2 => "N.P. Staff" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1212/WNL.0b013e3182684672" "Revista" => array:5 [ "tituloSerie" => "Neurology" "fecha" => "2012" "volumen" => "79" "paginaInicial" => "1070" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22946115" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0030" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "18F-FDG-PET/CT guiding to diagnosis of neurosarcoidosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "P. Guglielmo" 1 => "C. Crivellaro" 2 => "L. Marzorati" 3 => "M. Patassini" 4 => "S. Morzenti" 5 => "C. Landoni" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.remn.2016.12.001" "Revista" => array:6 [ "tituloSerie" => "Rev Esp Med Nucl Imagen Mol" "fecha" => "2017" "volumen" => "36" "paginaInicial" => "269" "paginaFinal" => "270" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28219645" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000015100000011/v1_201812070631/S2387020618304236/v1_201812070631/en/main.assets" "Apartado" => array:4 [ "identificador" => "43309" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000015100000011/v1_201812070631/S2387020618304236/v1_201812070631/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020618304236?idApp=UINPBA00004N" ]
