Practical Neurology

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Practical Neurology 2007;7:112-115
Copyright © 2007 by the BMJ Publishing Group Ltd.
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A difficult case

Refractory neurosarcoidosis responsive to infliximab

Christopher Kobylecki, Specialist Registrar in Neurology, Sandip Shaunak, Consultant Neurologist

Department of Neurology, Royal Preston Hospital, Fulwood, Preston, UK

Correspondence to:
Correspondence to:
Dr C Kobylecki
Royal Preston Hospital, Sharoe Green Lane North, Fulwood, Preston PR2 9HT, UK; ckobylecki@mac.com

The first 150 words of the full text of this article appear below.

A 35-year-old, right-handed man of Asian origin presented to the local ophthalmology service in June 2001 with headaches and decreasing visual acuity in the left eye, which progressed over one week to near-blindness. He had a left afferent pupillary defect and swollen left optic disc when seen in the ophthalmology clinic, with restricted elevation of the left eye. There was marked enlargement and peripheral gadolinium enhancement of the left optic nerve on MRI, but there were no brain lesions (fig 1Go).


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  		Figure 1 Axial fat-suppressed T1-weighted MRI brain scan, showing enlargement and gadolinium enhancement of the left optic nerve (arrow).

 
In November 2002 he underwent endoscopic biopsy of the left optic nerve, and this showed a patchy perivascular infiltrate of small mature-appearing B and T lymphocytes. Staining for glial fibrillary astrocytic protein (GFAP) was negative, favouring an inflammatory cause rather an intrinsic neoplasm. His visual symptoms were stable although he had . . . [Full text of this article]


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EDITOR’S CHOICE
Charles Warlow
Practical Neurology 2007 7: 69. [Extract] [Full Text] [PDF]





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