J Korean Neurosurg Soc.  2014 Jan;55(1):61-63. 10.3340/jkns.2014.55.1.61.

Solitary Cavernous Sinus Neurosarcoidosis Mimicking Neurosyphilis

• Kim DH
• Cho WH
• Cho KS
• Cha SH

• KMID: 2191045
• DOI: http://doi.org/10.3340/jkns.2014.55.1.61

Abstract

A differential diagnosis between neurosarcoidosis and neurosyphilis is particularly problematic in patients with a positive serologic result for syphilis. We report here a patient with a solitary cavernous sinus sarcoidosis who had a history of syphilis and showed rapidly progressing cavernous sinus syndrome. A transsphenoidal biopsy was performed and a histopathologic examination revealed a non-caseating granuloma with an asteroid body. His facial pain disappeared after steroid therapy. He received oral prednisolone for one year. A follow-up magnetic resonance imaging of the brain revealed resolution of the mass over the cavernous sinus. Particularly in patients with a history of syphilis, neurosyphilis should be included in a differential diagnosis of neurosarcoidosis.

Keyword

Neurosarcoidosis; Neurosyphilis; Sarcoidosis; Cavernous sinus

MeSH Terms

Biopsy
Brain
Cavernous Sinus*
Diagnosis, Differential
Facial Pain
Follow-Up Studies
Granuloma
Humans
Magnetic Resonance Imaging
Neurosyphilis*
Prednisolone
Sarcoidosis
Syphilis
Prednisolone

Figure

• 

  Fig. 1 Gadolinium-enhanced magnetic resonance (MR) images. A : Preoperative MR image revealing the mass extended toward the middle fossa laterally and to the sphenoid sinus anteriorly. This lesion also extended to the cerebellopontine angle posteriorly with a compression of the brain stem. B : Postoperative MR image revealing resolution of the mass over the cavernous sinus region sinus.

• 

  Fig. 2 Photomicrographs of the lesion showing a non-caseating granuloma (circle, A) with an asteroid body (arrow, B). H&E, original magnification, ×100 (A), ×400 (B).

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