结节病易误诊,据王洪武等~([1])收集国内18篇关于此病误诊的文献,误诊率高达63.2%,当然有误诊就会有误治,如孙永昌等~([2])报道26例结节病在影像学检查诊断的第一印象中拟诊结核5例,其中就有2例完成规范的抗结核治疗,为此应引起临床对本病诊治的重视。

Sarcoidosis

• Neurosarcoidosls is a disorder that is difficult to diagnose and manage. We assessed its neurological manifestations in 649 patients seen at The Johns Hopkins Hospital, Baltimore, from 1975 through 1980. Neurological problems could be attributed to neurosarcoidosis in 33 patients (5.1%). The presenting manifestation of sarcoidosis was neurological in 16 (48%) of them. Cranial neuropathy was the most frequent problem, and a peripheral facial nerve palsy was the single most common abnormality. Other manifestations were aseptic meningitis, hydrocephalus, parenchymatous disease of the central nervous system, peripheral neuropathy, and myopathy. Three-quarters of the patients were treated with steroids. The outcome was good in 27 (82%) of 33 episodes of neurological dysfunction in 25 patients with a well-documented clinical course. A thorough investigation of patients with suspected neurosarcoidosis is recommended to establish the diagnosis, delineate the extent of disease, and guide therapy.

https://jamanetwork.com/HttpHandlers/ArticlePdfHandler.ashx?journal=neur&articleId=584545&pdfFileName=archneur_42_9_022.pdf

Sarcoidosis and its neurological manifestations.

Nervous system involvement by sarcoidosis has been considered rare, yet more than 400 cases have been reported. We present 23 additional cases here, including 14 with autopsies, and we review the literature. The overall frequency of neurologic involvement is 5%. Patients usually have other stigmata of sarcoidosis; however, neurologic dysfunction is frequently the presenting finding. The protean manifestations of central nervous system (CNS) involvement usually occur in the early phase of the disease, while those of peripheral nervous system and skeletal muscle involvement are characteristically seen in the chronic stages. Basal granulomatous meningitis causes most of the CNS manifestations either by infiltration or compression of adjacent structures. Steroids are the mainstay of therapy, and the overall response is quite variable. The course is also variable, being transient in some and chronic in others. The prognosis is better with peripheral than with central nervous system involvement.

Neurologic manifestations in sarcoidosis: review of the literature, with a report of 23 cases.

A RECENT report to the National Advisory Neurological and Communicative Disorders and Stroke Council (1979) estimated that approximately 2 million American adults have disorders of taste and smell. For 1975 and 1976 combined, a chemosensory problem was the major presenting symptom in approximately 435,000 visits to a physician's office.1 In spite of the prevalence of chemosensory dysfunctions, medical textbooks provide little information on how to evaluate or treat them. Chronic disorders of taste and smell have been largely neglected because they are seldom fatal and, unlike deficiencies in sight or hearing, are not considered serious handicaps. In addition, they are . . .

Taste and smell in disease (first of two parts).

Recent years have witnessed a steady increasing interest in olfaction by both clinicians and basic scientists along with a profusion of new techniques that allow a closer look at the anatomy and physiology of olfaction. In response to these rapid developments, the editors have compiled "The Science of Olfaction", a comprehensive, interdisciplinary reference that bridges the gap between recent basic science and clinical work in the fields. The papers present the current state of knowledge regarding the sense of olfaction and its relationship to the brain. The material ranges from the molecular architecture of olfaction to its cognitive-sensory links and dissolution in disease and contributes significantly to the understanding of the puzzle that makes up the study of brain function.

Science of olfaction

• Changes in the olfactory system in five patients with sarcoidosis were studied by clinical and histopathological examination. Every patient studied had hypogeusia and/or hyposmia as measured by psychophysical testing. In two patients who died with this disease, the olfactory bulbs and tracts were involved by granulomatous infiltration. Two other patients showed granulomas and chronic inflammation in nasal biopsy specimens. The fifth patient was studied only clinically. Changes in olfactory and gustatory acuity are rarely searched for in patients with sarcoidosis, but they may be important indicators of major and later irreversible damage to the CNS. If diminished olfaction is established in suspect patients, nasal biopsy and examination of the CNS should be performed to confirm the presence of active sarcoidosis. Appropriate therapy may prevent damage to the patient's sensory capabilities and CNS function.

Olfactory Sarcoidosis: Report of Five Cases and Review of the Literature

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Olfactory Sarcoidosis: Report of Five Cases and Review of the Literature