A 28-year-old man with headache, hallucination, and visual disturbances for 1 year.
What is your diagnosis?
A. Neurosarcoidosis
B. CLIPPERS
C. Malignant lymphoma
D. Behçet disease
A.
B.
C.
D.
?
?
?
The answer is Neurosarcoidosis
Sarcoidosis is a multisystem granulomatous inflammatory disease of unknown etiology.
Neurosarcoidosis refers to the involvement of the CNS and preferentially affects cranial nerves, leptomeninges, and perivascular spaces.
The classic MR imaging features include subtle T2WI brain stem-hyperintense lesions (A and C, arrows) and leptomeningeal enhancing hyperintensities in the brain stem, cerebellum, and cerebral cortices (B and D, arrows), as well as extensive perivascular hyperintensities in the brain stem on contrast-enhanced T1WI (B and D, arrowheads).
中文版：
男性，28歲，頭痛、幻覺、視覺障礙1年
診斷？
A. 神經系統結節病
B. CLIPPERS綜合症（類固醇激素反應性慢性淋巴細胞性炎症伴腦橋血管周圍強化症）
C. 惡性淋巴瘤
D. Behçet 病
診斷：神經系統結節病
結節病是一種累及多系統的肉芽腫性炎性疾病，其病因不明。
當結節病累及中樞神經系統時稱為神經系統結節病，好發於顱神經、軟腦膜及血管周圍間隙。
典型MRI表現：T2WI可見腦橋細微高信號影（A,C箭頭），T1WI增強表現為腦幹、小腦以及大腦皮層軟腦膜強化（B,D箭頭），腦幹內血管周圍間隙亦呈瀰漫性強化（B,D箭頭）。
From AJNR Classic Case