脳出血で発症した神経サルコイドーシスの1例

CNS Sarcoidosis Presenting with Intracerebral Hemorrhage：Case Report

Ⅰ．は じ め に

　サルコイドーシスは非乾酪性類上皮性肉芽腫を特徴とする，全身性の疾患である．肺とぶどう膜が好発部位であるが，約5％の症例で中枢神経（central nervous system；CNS）にも病変が出現するとされている¹⁶⁾．しかし，欧米と比べると，わが国における報告はそれほど多くない．CNSサルコイドーシスは病変の部位によって，脳神経症状や痙攣など，多彩な神経症状を呈することが知られているが^2,6,11,12)，脳出血を来した症例が数例のみ報告されているに過ぎない^1,3,4,14)．今回われわれは，大脳皮質に発生したサルコイドーシスにより皮質下出血が生じ，痙攣重積発作で発症した1例を経験したので報告する．

　Sarcoidosis is a systemic,chronic inflammatory disease characterized by non-caseating epithelioid granuloma. It is well known that the central nervous system (CNS) is also involved in about 5％ of patients with systemic sarcoidosis. Although CNS sarcoidosis presents with various neurological manifestations,intracerebral bleeding is quite rare. In this report,we describe a case in which a patient suffered from intracerebral hemorrhagic due to CNS sarcoidosis. A 57-year-old male who had been diagnosed as having systemic sarcoidosis was admitted to our hospital due to status epilepticus. Plain CT scan showed a subcortical hematoma in the left marginal gyrus. Serial MR imaging revealed that an enhanced mass in the overlying cortex had gradually increased its size. Subsequently,the enhanced mass and hematoma were totally removed,using a navigation system. Pathological examination revealed typical findings of sarcoidosis. We discuss the mechanism of intracerebral bleeding due to CNS sarcoidosis in this report.