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The infectious etiology of sarcoidosis has never been established, but the disease may suitably be considered at this point because of its close resemblance pathologically and clinically to tuberculosis and other granulomatous infections Indeed, one still credible theory of causation considers sarcoidosis to be a modi ed form or product of the tubercle bacillus This has not been proved, and the same can be said for various other infectious and noninfectious etiologies that from time to time have been proposed as the underlying cause Current opinion favors the idea that sarcoidosis represents an exaggerated cellular immune response to a limited class of antigens or autoantigens (Crystal) The essential lesion in sarcoidosis consists of focal collections of epithelioid cells surrounded by a rim of lymphocytes; frequently there are giant cells, but caseation is lacking The sarcoid tubercles may be found in all organs and tissues including the peripheral and CNS, but the most frequently involved are the mediastinal and peripheral lymph nodes, lungs, liver, skin, phalangeal bones, eyes, and parotid glands Sarcoidosis is accompanied by nervous system involvement (neurosarcoidosis) in approximately 5 percent of cases according to the worldwide surveys of Delaney and of Siltzbach and colleagues It may take any one of several forms As indicated in Chaps 13, 46 and 47, isolated sarcoid granulomas may involve peripheral or cranial nerves, giving rise to a subacute or chronic neuropathy or plexopathy of asymmetrical type (Jefferson) Polyneuropathy may occur but is rare; Zuniga and colleagues have summarized our own experience Of the cranial nerves, the facial is the most frequently involved, either as part of the uveoparotid syndrome (Heerfordt syndrome) or independently The facial palsy may be unilateral or bilateral; if the latter, the nerves may be affected simultaneously or in succession The occurrence of hyperacusis indicates that the lesion is central to the stylomastoid foramen Blindness may follow basal in ltration that encompasses the optic nerves (Fig 32-4) CNS sarcoidosis is said to be infrequent, but we encounter one or more cases yearly Several syndromes are known that are due to localized involvement of the meninges, brain, and spinal cord (Table 32-5) In Scadding s series of 275 patients, only 3 developed CNS lesions; in other large series, the incidence of CNS involvement was greater, but most are in the range of 5 to 10 percent (10 of 145 patients studied by Mayock et al; 14 of 285, by Chen and McLeod; and 33 of 649, by Stern et al) Delaney, in his review of the literature, found the neurologic involvement in sar-. rdlc gs1 128 Packages matching GS1-128 - NuGet Gallery
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ssrs 2016 barcode generate GS1 - 128 using C# barcode SDK, create EAN/ UCC - 128 using C# barcode component, make EAN128 using C# barcode DLL, generate GS1 - 128 using ... ssrs qr code free Table 32-5 Nervous system manifestations of sarcoidosis Aseptic meningitis: chronic or relapsing, with or without headache Pachymeningitis: hydrocephalus Brain Focal tumor-like mass: seizures, hemiparesis Cortical and subcortical in ltration; amnestic-dementing syndrome, encephalopathy, headache Hypothalamic-basilar in ltration: diabetes insipidus, abulia Spinal cord and roots Granulomatous meningomyelitis, subacute or chronic Cauda equina syndrome Peripheral nervous system Lumbar or brachial plexopathy Sensory-predominant polyneuropathy Mononeuropathy Mononeuritis multiplex Cranial neuropathy Visual loss Papillitis Facial palsy, unilateral, bilateral, or sequential Hearing loss, vertigo Facial sensory loss or neuralgia rdlc ean 128 GS1 - 128 / EAN - 128 Barcode Generation SDK for RDLC
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