末梢神経サルコイドーシス

Sarcoid Neuropathy

サルコイドニューロパチーの臨床像は非常に多様である。多発性単神経型の分布が典型的であるが，ポリニューロパチー様の分布を示すことも多い。その際にも左右差や神経根障害を反映した四肢近位部優位の症候，末梢神経の分枝レベルの感覚障害，疼痛などの陽性症状を伴う感覚障害があれば，本症を疑う根拠となる。電気生理的には軸索障害が不均一な広がりをもって見られるが，時に脱髄様の変化を示すことから他疾患との鑑別診断が問題となる。

Abstract

Sarcoid neuropathy has a broader spectrum of clinical features than previously expected. It is typically characterized by multiple mononeuropathy but often shows a polyneuropathy pattern, making it difficult to be differentiated from other neuropathies. In the diagnostic process, several clinical features, including laterality and proximal-predominance of symptoms at extremities, sensory deficits in the territory of the branch of the peripheral nerve trunk, and positive neuropathic sensory symptoms typically accompanied by pain, could be the cues to evaluate the probability of sarcoid neuropathy. Axonal disturbance with a patchy distribution is a rule in nerve conduction studies; however, abnormalities suggestive of demyelination are also seen, imitating the clinical picture of chronic inflammatory demyelinating polyneuropathy.