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Acceso abierto<\/p>\n
[\/et_pb_text][et_pb_text _builder_version=\u00bb4.16.0″ _dynamic_attributes=\u00bbcontent\u00bb text_font=\u00bbEB Garamond||||||||\u00bb text_text_color=\u00bb#000000″ text_font_size=\u00bb50px\u00bb text_line_height=\u00bb1.3em\u00bb header_font=\u00bbEB Garamond||||||||\u00bb header_font_size=\u00bb54px\u00bb header_line_height=\u00bb1.3em\u00bb header_4_font=\u00bb|700||on|||||\u00bb header_4_font_size=\u00bb16px\u00bb header_4_letter_spacing=\u00bb2px\u00bb header_4_line_height=\u00bb2em\u00bb max_width=\u00bb900px\u00bb text_font_size_tablet=\u00bb\u00bb text_font_size_phone=\u00bb15px\u00bb text_font_size_last_edited=\u00bbon|tablet\u00bb text_line_height_tablet=\u00bb\u00bb text_line_height_phone=\u00bb1.6em\u00bb text_line_height_last_edited=\u00bbon|phone\u00bb header_font_size_tablet=\u00bb50px\u00bb header_font_size_phone=\u00bb32px\u00bb header_font_size_last_edited=\u00bbon|phone\u00bb locked=\u00bboff\u00bb global_colors_info=\u00bb{}\u00bb]@ET-DC@eyJkeW5hbWljIjp0cnVlLCJjb250ZW50IjoicG9zdF90aXRsZSIsInNldHRpbmdzIjp7ImJlZm9yZSI6IiIsImFmdGVyIjoiIn19@[\/et_pb_text][et_pb_blurb title=\u00bbMilagros Valdez (1)\u00bb use_icon=\u00bbon\u00bb font_icon=\u00bb||divi||400″ icon_color=\u00bb#3cbebe\u00bb icon_placement=\u00bbleft\u00bb content_max_width=\u00bb1100px\u00bb image_icon_width_last_edited=\u00bboff|desktop\u00bb _builder_version=\u00bb4.27.4″ header_font=\u00bb|600|||||||\u00bb header_font_size=\u00bb18px\u00bb header_line_height=\u00bb1.6em\u00bb body_font=\u00bb||||||||\u00bb body_font_size=\u00bb15px\u00bb body_line_height=\u00bb2em\u00bb custom_margin=\u00bb||8px|||\u00bb header_font_size_tablet=\u00bb\u00bb header_font_size_phone=\u00bb15px\u00bb header_font_size_last_edited=\u00bbon|phone\u00bb body_line_height_tablet=\u00bb\u00bb body_line_height_phone=\u00bb1.6em\u00bb body_line_height_last_edited=\u00bbon|phone\u00bb image_max_width_phone=\u00bb50px\u00bb image_max_width_last_edited=\u00bboff|desktop\u00bb locked=\u00bboff\u00bb global_colors_info=\u00bb{}\u00bb]<\/p>\n
(1)<\/sup> Residente de Diagn\u00f3stico por Im\u00e1genes [\/et_pb_blurb][et_pb_text _builder_version=\u00bb4.27.4″ text_font=\u00bb||||||||\u00bb text_font_size=\u00bb13px\u00bb text_line_height=\u00bb1.6em\u00bb header_font=\u00bb||||||||\u00bb header_2_font=\u00bb||||||||\u00bb header_3_font=\u00bbEB Garamond||||||||\u00bb header_3_font_size=\u00bb24px\u00bb header_3_line_height=\u00bb1.4em\u00bb header_4_font=\u00bb|700||on|||||\u00bb header_4_text_color=\u00bb#ffdaa4″ header_4_font_size=\u00bb12px\u00bb header_4_letter_spacing=\u00bb2px\u00bb header_4_line_height=\u00bb2em\u00bb hover_enabled=\u00bb0″ text_line_height_tablet=\u00bb\u00bb text_line_height_phone=\u00bb1.6em\u00bb text_line_height_last_edited=\u00bbon|phone\u00bb global_colors_info=\u00bb{}\u00bb sticky_enabled=\u00bb0″]<\/p>\n Citaci\u00f3n sugerida:<\/strong> Valdez M. Paciente con parestesias: un desaf\u00edo diagn\u00f3stico. Anuario (Fund. Dr. J. R. Villavicencio) 2025;32. Disponible en: https:\/\/villavicencio.org.ar\/anuario\/32-paciente-con-parestesias<\/a>. ARK: https:\/\/id.caicyt.gov.ar\/ark:\/s2796762x\/u4nraymkl<\/a><\/span><\/p>\n Este es un art\u00edculo de acceso abierto distribuido bajo los t\u00e9rminos de Creative Commons Attribution License (https:\/\/creativecommons.org\/licenses\/by-nc-sa\/4.0\/deed.es), esto permite que Ud. lo use, lo distribuya y lo adapte, sin prop\u00f3sitos comerciales, siempre que se cite correctamente el trabajo original. Si crea un nuevo material con \u00e9l, debe distribuirlo con la misma licencia.<\/p>\n [\/et_pb_text][et_pb_button button_url=\u00bb\/anuario\/32\/paciente-con-parestesias.pdf\u00bb url_new_window=\u00bbon\u00bb button_text=\u00bbDescargar art\u00edculo\u00bb button_alignment=\u00bbright\u00bb _builder_version=\u00bb4.27.4″ custom_button=\u00bbon\u00bb button_text_size=\u00bb12px\u00bb button_text_color=\u00bb#3cbebe\u00bb button_bg_color=\u00bbrgba(60,190,190,0.1)\u00bb button_border_width=\u00bb10px\u00bb button_border_color=\u00bbrgba(0,0,0,0)\u00bb button_border_radius=\u00bb100px\u00bb button_letter_spacing=\u00bb1px\u00bb button_font=\u00bb|700||on|||||\u00bb custom_padding=\u00bb10px|20px|10px|20px|true|true\u00bb button_letter_spacing_hover=\u00bb1px\u00bb locked=\u00bboff\u00bb global_colors_info=\u00bb{}\u00bb button_text_size__hover_enabled=\u00bboff\u00bb button_one_text_size__hover_enabled=\u00bboff\u00bb button_two_text_size__hover_enabled=\u00bboff\u00bb button_text_color__hover_enabled=\u00bboff\u00bb button_one_text_color__hover_enabled=\u00bboff\u00bb button_two_text_color__hover_enabled=\u00bboff\u00bb button_border_width__hover_enabled=\u00bboff\u00bb button_one_border_width__hover_enabled=\u00bboff\u00bb button_two_border_width__hover_enabled=\u00bboff\u00bb button_border_color__hover_enabled=\u00bboff\u00bb button_one_border_color__hover_enabled=\u00bboff\u00bb button_two_border_color__hover_enabled=\u00bboff\u00bb button_border_radius__hover_enabled=\u00bboff\u00bb button_one_border_radius__hover_enabled=\u00bboff\u00bb button_two_border_radius__hover_enabled=\u00bboff\u00bb button_letter_spacing__hover_enabled=\u00bbon\u00bb button_letter_spacing__hover=\u00bb1px\u00bb button_one_letter_spacing__hover_enabled=\u00bboff\u00bb button_two_letter_spacing__hover_enabled=\u00bboff\u00bb button_bg_color__hover_enabled=\u00bboff\u00bb button_one_bg_color__hover_enabled=\u00bboff\u00bb button_two_bg_color__hover_enabled=\u00bboff\u00bb][\/et_pb_button][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=\u00bb1″ admin_label=\u00bbCourses\u00bb _builder_version=\u00bb4.16″ custom_padding=\u00bb1px|0px|62px|0px|false|false\u00bb collapsed=\u00bboff\u00bb global_colors_info=\u00bb{}\u00bb][et_pb_row custom_padding_last_edited=\u00bbon|phone\u00bb _builder_version=\u00bb4.16″ background_color=\u00bb#ffffff\u00bb max_width=\u00bb1280px\u00bb custom_padding=\u00bb12px|40px|12px|40px|true|false\u00bb custom_padding_tablet=\u00bb\u00bb custom_padding_phone=\u00bb|20px||20px||true\u00bb animation_style=\u00bbzoom\u00bb animation_intensity_zoom=\u00bb2%\u00bb border_radii=\u00bbon|12px|12px|12px|12px\u00bb box_shadow_style=\u00bbpreset1″ box_shadow_vertical=\u00bb50px\u00bb box_shadow_blur=\u00bb80px\u00bb box_shadow_color=\u00bbrgba(15,19,25,0.1)\u00bb use_custom_width=\u00bbon\u00bb custom_width_px=\u00bb1280px\u00bb global_colors_info=\u00bb{}\u00bb][et_pb_column type=\u00bb4_4″ _builder_version=\u00bb4.16″ custom_padding=\u00bb|||\u00bb global_colors_info=\u00bb{}\u00bb custom_padding__hover=\u00bb|||\u00bb][et_pb_text _builder_version=\u00bb4.27.4″ text_font=\u00bb||||||||\u00bb text_font_size=\u00bb15px\u00bb text_line_height=\u00bb2em\u00bb header_font=\u00bb||||||||\u00bb header_2_font=\u00bb||||||||\u00bb header_3_font=\u00bbEB Garamond||||||||\u00bb header_3_font_size=\u00bb24px\u00bb header_3_line_height=\u00bb1.4em\u00bb header_4_font=\u00bb|700||on|||||\u00bb header_4_text_color=\u00bb#ffdaa4″ header_4_font_size=\u00bb12px\u00bb header_4_letter_spacing=\u00bb2px\u00bb header_4_line_height=\u00bb2em\u00bb text_line_height_tablet=\u00bb\u00bb text_line_height_phone=\u00bb1.6em\u00bb text_line_height_last_edited=\u00bbon|phone\u00bb global_colors_info=\u00bb{}\u00bb]<\/p>\n La sarcoidosis es un trastorno inmunitario multisist\u00e9mico que se puede manifestar en diferentes \u00f3rganos y sistemas y afecta al sistema nervioso solo en el 10\u00a0% de los casos. [\/et_pb_text][et_pb_text _builder_version=\u00bb4.27.4″ text_font=\u00bb||||||||\u00bb text_font_size=\u00bb15px\u00bb text_line_height=\u00bb2em\u00bb header_font=\u00bb||||||||\u00bb header_2_font=\u00bb||||||||\u00bb header_3_font=\u00bbEB Garamond||||||||\u00bb header_3_font_size=\u00bb24px\u00bb header_3_line_height=\u00bb1.4em\u00bb header_4_font=\u00bb|700||on|||||\u00bb header_4_text_color=\u00bb#ffdaa4″ header_4_font_size=\u00bb12px\u00bb header_4_letter_spacing=\u00bb2px\u00bb header_4_line_height=\u00bb2em\u00bb text_line_height_tablet=\u00bb\u00bb text_line_height_phone=\u00bb1.6em\u00bb text_line_height_last_edited=\u00bbon|phone\u00bb locked=\u00bboff\u00bb global_colors_info=\u00bb{}\u00bb]<\/p>\n Sarcoidosis, neurosarcoidosis espinal, parestesias, neuroinmunolog\u00eda.<\/p>\n [\/et_pb_text][et_pb_text _builder_version=\u00bb4.27.4″ text_font=\u00bb||||||||\u00bb text_font_size=\u00bb15px\u00bb text_line_height=\u00bb2em\u00bb header_font=\u00bb||||||||\u00bb header_2_font=\u00bb||||||||\u00bb header_3_font=\u00bbEB Garamond||||||||\u00bb header_3_font_size=\u00bb24px\u00bb header_3_line_height=\u00bb1.4em\u00bb header_4_font=\u00bb|700||on|||||\u00bb header_4_text_color=\u00bb#ffdaa4″ header_4_font_size=\u00bb12px\u00bb header_4_letter_spacing=\u00bb2px\u00bb header_4_line_height=\u00bb2em\u00bb text_line_height_tablet=\u00bb\u00bb text_line_height_phone=\u00bb1.6em\u00bb text_line_height_last_edited=\u00bbon|phone\u00bb locked=\u00bboff\u00bb global_colors_info=\u00bb{}\u00bb]<\/p>\n [\/et_pb_text][et_pb_text _builder_version=\u00bb4.27.4″ text_font=\u00bb||||||||\u00bb text_font_size=\u00bb15px\u00bb text_line_height=\u00bb2em\u00bb header_font=\u00bb||||||||\u00bb header_2_font=\u00bb||||||||\u00bb header_3_font=\u00bbEB Garamond||||||||\u00bb header_3_font_size=\u00bb24px\u00bb header_3_line_height=\u00bb1.4em\u00bb header_4_font=\u00bb|700||on|||||\u00bb header_4_text_color=\u00bb#ffdaa4″ header_4_font_size=\u00bb12px\u00bb header_4_letter_spacing=\u00bb2px\u00bb header_4_line_height=\u00bb2em\u00bb text_line_height_tablet=\u00bb\u00bb text_line_height_phone=\u00bb1.6em\u00bb text_line_height_last_edited=\u00bbon|phone\u00bb locked=\u00bboff\u00bb global_colors_info=\u00bb{}\u00bb]<\/p>\n Sarcoidosis is a multisystem immune disorder that can manifest in different organs and systems; it affects the nervous system in only 10% of the cases. Treatment with corticosteroids is usually associated with a favorable outcome. [\/et_pb_text][et_pb_text _builder_version=\u00bb4.27.4″ text_font=\u00bb||||||||\u00bb text_font_size=\u00bb15px\u00bb text_line_height=\u00bb2em\u00bb header_font=\u00bb||||||||\u00bb header_2_font=\u00bb||||||||\u00bb header_3_font=\u00bbEB Garamond||||||||\u00bb header_3_font_size=\u00bb24px\u00bb header_3_line_height=\u00bb1.4em\u00bb header_4_font=\u00bb|700||on|||||\u00bb header_4_text_color=\u00bb#ffdaa4″ header_4_font_size=\u00bb12px\u00bb header_4_letter_spacing=\u00bb2px\u00bb header_4_line_height=\u00bb2em\u00bb text_line_height_tablet=\u00bb\u00bb text_line_height_phone=\u00bb1.6em\u00bb text_line_height_last_edited=\u00bbon|phone\u00bb locked=\u00bboff\u00bb global_colors_info=\u00bb{}\u00bb]<\/p>\n Sarcoidosis; spinal neurosarcoidosis; paresthesias, neuroimmunology.<\/p>\n [\/et_pb_text][et_pb_text _builder_version=\u00bb4.27.4″ text_font=\u00bb||||||||\u00bb text_font_size=\u00bb15px\u00bb text_line_height=\u00bb2em\u00bb header_font=\u00bb||||||||\u00bb header_2_font=\u00bb||||||||\u00bb header_3_font=\u00bbEB Garamond||||||||\u00bb header_3_font_size=\u00bb24px\u00bb header_3_line_height=\u00bb1.4em\u00bb header_4_font=\u00bb|700||on|||||\u00bb header_4_text_color=\u00bb#ffdaa4″ header_4_font_size=\u00bb12px\u00bb header_4_letter_spacing=\u00bb2px\u00bb header_4_line_height=\u00bb2em\u00bb text_line_height_tablet=\u00bb\u00bb text_line_height_phone=\u00bb1.6em\u00bb text_line_height_last_edited=\u00bbon|phone\u00bb locked=\u00bboff\u00bb global_colors_info=\u00bb{}\u00bb]<\/p>\n La sarcoidosis es una enfermedad granulomatosa multisist\u00e9mica de causa desconocida que afecta principalmente a los pulmones, ganglios linf\u00e1ticos, piel y ojos. La neurosarcoidosis es una manifestaci\u00f3n rara, afectando al 15 % de los casos, con compromiso del sistema nervioso central o perif\u00e9rico. [\/et_pb_text][et_pb_text _builder_version=\u00bb4.27.4″ text_font=\u00bb||||||||\u00bb text_font_size=\u00bb15px\u00bb text_line_height=\u00bb2em\u00bb header_font=\u00bb||||||||\u00bb header_2_font=\u00bb||||||||\u00bb header_3_font=\u00bbEB Garamond||||||||\u00bb header_3_font_size=\u00bb24px\u00bb header_3_line_height=\u00bb1.4em\u00bb header_4_font=\u00bb|700||on|||||\u00bb header_4_text_color=\u00bb#ffdaa4″ header_4_font_size=\u00bb12px\u00bb header_4_letter_spacing=\u00bb2px\u00bb header_4_line_height=\u00bb2em\u00bb text_line_height_tablet=\u00bb\u00bb text_line_height_phone=\u00bb1.6em\u00bb text_line_height_last_edited=\u00bbon|phone\u00bb locked=\u00bboff\u00bb global_colors_info=\u00bb{}\u00bb]<\/p>\n [\/et_pb_text][et_pb_text _builder_version=\u00bb4.27.4″ text_font=\u00bb||||||||\u00bb text_font_size=\u00bb15px\u00bb text_line_height=\u00bb2em\u00bb header_font=\u00bb||||||||\u00bb header_2_font=\u00bb||||||||\u00bb header_3_font=\u00bbEB Garamond||||||||\u00bb header_3_font_size=\u00bb24px\u00bb header_3_line_height=\u00bb1.4em\u00bb header_4_font=\u00bb|700||on|||||\u00bb header_4_text_color=\u00bb#ffdaa4″ header_4_font_size=\u00bb12px\u00bb header_4_letter_spacing=\u00bb2px\u00bb header_4_line_height=\u00bb2em\u00bb text_line_height_tablet=\u00bb\u00bb text_line_height_phone=\u00bb1.6em\u00bb text_line_height_last_edited=\u00bbon|phone\u00bb locked=\u00bboff\u00bb global_colors_info=\u00bb{}\u00bb]<\/p>\n Paciente masculino de 48 a\u00f1os present\u00f3 un cuadro de inicio insidioso, de un mes de evoluci\u00f3n, caracterizado por parestesias en ambos miembros inferiores, sensaci\u00f3n de torpeza sin alteraci\u00f3n motora y dificultad en la micci\u00f3n. [\/et_pb_text][et_pb_text _builder_version=\u00bb4.27.4″ text_font=\u00bb||||||||\u00bb text_font_size=\u00bb15px\u00bb text_line_height=\u00bb2em\u00bb header_font=\u00bb||||||||\u00bb header_2_font=\u00bb||||||||\u00bb header_3_font=\u00bbEB Garamond||||||||\u00bb header_3_font_size=\u00bb24px\u00bb header_3_line_height=\u00bb1.4em\u00bb header_4_font=\u00bb|700||on|||||\u00bb header_4_text_color=\u00bb#ffdaa4″ header_4_font_size=\u00bb12px\u00bb header_4_letter_spacing=\u00bb2px\u00bb header_4_line_height=\u00bb2em\u00bb text_line_height_tablet=\u00bb\u00bb text_line_height_phone=\u00bb1.6em\u00bb text_line_height_last_edited=\u00bbon|phone\u00bb locked=\u00bboff\u00bb global_colors_info=\u00bb{}\u00bb]<\/p>\n La sarcoidosis es una enfermedad compleja y multisist\u00e9mica que presenta un desaf\u00edo diagn\u00f3stico significativo, especialmente cuando afecta al sistema nervioso. En este caso, la presentaci\u00f3n subaguda de parestesias en el paciente subraya la dificultad de distinguir la neurosarcoidosis espinal de otras enfermedades desmielinizantes. La similitud cl\u00ednica con estas patolog\u00edas puede retrasar el diagn\u00f3stico y, por ende, el inicio del tratamiento adecuado. [\/et_pb_text][et_pb_text _builder_version=\u00bb4.27.4″ text_font=\u00bb||||||||\u00bb text_font_size=\u00bb15px\u00bb text_line_height=\u00bb2em\u00bb header_font=\u00bb||||||||\u00bb header_2_font=\u00bb||||||||\u00bb header_3_font=\u00bbEB Garamond||||||||\u00bb header_3_font_size=\u00bb24px\u00bb header_3_line_height=\u00bb1.4em\u00bb header_4_font=\u00bb|700||on|||||\u00bb header_4_text_color=\u00bb#ffdaa4″ header_4_font_size=\u00bb12px\u00bb header_4_letter_spacing=\u00bb2px\u00bb header_4_line_height=\u00bb2em\u00bb text_line_height_tablet=\u00bb\u00bb text_line_height_phone=\u00bb1.6em\u00bb text_line_height_last_edited=\u00bbon|phone\u00bb locked=\u00bboff\u00bb global_colors_info=\u00bb{}\u00bb]<\/p>\n En conclusi\u00f3n, la neurosarcoidosis espinal, aunque rara, debe ser considerada en pacientes con s\u00edntomas neurol\u00f3gicos at\u00edpicos y un curso cl\u00ednico que no se ajusta a otras enfermedades m\u00e1s comunes. La identificaci\u00f3n temprana y el tratamiento adecuado son esenciales para mejorar el pron\u00f3stico y la calidad de vida de los pacientes afectados.<\/p>\n [\/et_pb_text][et_pb_text _builder_version=\u00bb4.16″ text_font=\u00bb||||||||\u00bb text_font_size=\u00bb15px\u00bb text_line_height=\u00bb2em\u00bb header_font=\u00bb||||||||\u00bb header_2_font=\u00bb||||||||\u00bb header_3_font=\u00bbEB Garamond||||||||\u00bb header_3_font_size=\u00bb24px\u00bb header_3_line_height=\u00bb1.4em\u00bb header_4_font=\u00bb|700||on|||||\u00bb header_4_text_color=\u00bb#ffdaa4″ header_4_font_size=\u00bb12px\u00bb header_4_letter_spacing=\u00bb2px\u00bb header_4_line_height=\u00bb2em\u00bb text_line_height_tablet=\u00bb\u00bb text_line_height_phone=\u00bb1.6em\u00bb text_line_height_last_edited=\u00bbon|phone\u00bb locked=\u00bboff\u00bb global_colors_info=\u00bb{}\u00bb]<\/p>\n Los autores declaran no tener conflicto de intereses.<\/p>\n [\/et_pb_text][et_pb_text _builder_version=\u00bb4.16″ text_font=\u00bb||||||||\u00bb text_font_size=\u00bb15px\u00bb text_line_height=\u00bb2em\u00bb header_font=\u00bb||||||||\u00bb header_2_font=\u00bb||||||||\u00bb header_3_font=\u00bbEB Garamond||||||||\u00bb header_3_font_size=\u00bb24px\u00bb header_3_line_height=\u00bb1.4em\u00bb header_4_font=\u00bb|700||on|||||\u00bb header_4_text_color=\u00bb#ffdaa4″ header_4_font_size=\u00bb12px\u00bb header_4_letter_spacing=\u00bb2px\u00bb header_4_line_height=\u00bb2em\u00bb text_line_height_tablet=\u00bb\u00bb text_line_height_phone=\u00bb1.6em\u00bb text_line_height_last_edited=\u00bbon|phone\u00bb global_colors_info=\u00bb{}\u00bb][\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=\u00bb1″ admin_label=\u00bbTablas\u00bb _builder_version=\u00bb4.16″ custom_padding=\u00bb1px|0px|62px|0px|false|false\u00bb locked=\u00bboff\u00bb collapsed=\u00bboff\u00bb global_colors_info=\u00bb{}\u00bb][et_pb_row custom_padding_last_edited=\u00bbon|phone\u00bb _builder_version=\u00bb4.16″ background_color=\u00bb#ffffff\u00bb max_width=\u00bb1280px\u00bb custom_padding=\u00bb12px|40px|12px|40px|true|false\u00bb custom_padding_tablet=\u00bb\u00bb custom_padding_phone=\u00bb|20px||20px||true\u00bb animation_style=\u00bbzoom\u00bb animation_intensity_zoom=\u00bb2%\u00bb border_radii=\u00bbon|12px|12px|12px|12px\u00bb box_shadow_style=\u00bbpreset1″ box_shadow_vertical=\u00bb50px\u00bb box_shadow_blur=\u00bb80px\u00bb box_shadow_color=\u00bbrgba(15,19,25,0.1)\u00bb use_custom_width=\u00bbon\u00bb custom_width_px=\u00bb1280px\u00bb global_colors_info=\u00bb{}\u00bb][et_pb_column type=\u00bb4_4″ _builder_version=\u00bb4.16″ custom_padding=\u00bb|||\u00bb global_colors_info=\u00bb{}\u00bb custom_padding__hover=\u00bb|||\u00bb][et_pb_text _builder_version=\u00bb4.27.4″ text_font=\u00bb||||||||\u00bb text_font_size=\u00bb15px\u00bb text_line_height=\u00bb2em\u00bb header_font=\u00bb||||||||\u00bb header_2_font=\u00bb||||||||\u00bb header_3_font=\u00bbEB Garamond||||||||\u00bb header_3_font_size=\u00bb24px\u00bb header_3_line_height=\u00bb1.4em\u00bb header_4_font=\u00bb|700||on|||||\u00bb header_4_text_color=\u00bb#ffdaa4″ header_4_font_size=\u00bb12px\u00bb header_4_letter_spacing=\u00bb2px\u00bb header_4_line_height=\u00bb2em\u00bb text_line_height_tablet=\u00bb\u00bb text_line_height_phone=\u00bb1.6em\u00bb text_line_height_last_edited=\u00bbon|phone\u00bb locked=\u00bboff\u00bb global_colors_info=\u00bb{}\u00bb]<\/p>\n Figura 1-a: Primera resonancia magn\u00e9tica de columna total<\/strong><\/p>\n [\/et_pb_text][et_pb_image src=\u00bbhttps:\/\/villavicencio.org.ar\/anuario\/wp-content\/uploads\/2025\/05\/Parestesias-1A.jpg\u00bb title_text=\u00bbParestesias 1A\u00bb align=\u00bbcenter\u00bb _builder_version=\u00bb4.27.4″ _module_preset=\u00bbdefault\u00bb global_colors_info=\u00bb{}\u00bb][\/et_pb_image][\/et_pb_column][\/et_pb_row][et_pb_row custom_padding_last_edited=\u00bbon|phone\u00bb _builder_version=\u00bb4.16″ background_color=\u00bb#ffffff\u00bb max_width=\u00bb1280px\u00bb custom_padding=\u00bb12px|40px|12px|40px|true|false\u00bb custom_padding_tablet=\u00bb\u00bb custom_padding_phone=\u00bb|20px||20px||true\u00bb animation_style=\u00bbzoom\u00bb animation_intensity_zoom=\u00bb2%\u00bb border_radii=\u00bbon|12px|12px|12px|12px\u00bb box_shadow_style=\u00bbpreset1″ box_shadow_vertical=\u00bb50px\u00bb box_shadow_blur=\u00bb80px\u00bb box_shadow_color=\u00bbrgba(15,19,25,0.1)\u00bb use_custom_width=\u00bbon\u00bb custom_width_px=\u00bb1280px\u00bb global_colors_info=\u00bb{}\u00bb][et_pb_column type=\u00bb4_4″ _builder_version=\u00bb4.16″ custom_padding=\u00bb|||\u00bb global_colors_info=\u00bb{}\u00bb custom_padding__hover=\u00bb|||\u00bb][et_pb_text _builder_version=\u00bb4.27.4″ text_font=\u00bb||||||||\u00bb text_font_size=\u00bb15px\u00bb text_line_height=\u00bb2em\u00bb header_font=\u00bb||||||||\u00bb header_2_font=\u00bb||||||||\u00bb header_3_font=\u00bbEB Garamond||||||||\u00bb header_3_font_size=\u00bb24px\u00bb header_3_line_height=\u00bb1.4em\u00bb header_4_font=\u00bb|700||on|||||\u00bb header_4_text_color=\u00bb#ffdaa4″ header_4_font_size=\u00bb12px\u00bb header_4_letter_spacing=\u00bb2px\u00bb header_4_line_height=\u00bb2em\u00bb text_line_height_tablet=\u00bb\u00bb text_line_height_phone=\u00bb1.6em\u00bb text_line_height_last_edited=\u00bbon|phone\u00bb locked=\u00bboff\u00bb global_colors_info=\u00bb{}\u00bb]<\/p>\n Figura 1-b: Primera resonancia magn\u00e9tica de columna total<\/strong><\/p>\n Se puede visualizar a nivel dorsal una extensa alteraci\u00f3n de la se\u00f1al del cord\u00f3n medular siendo hiperintenso en T2 y STIR de D2 a D10 inclusive. Realce intenso de aspecto parcheado con mayor compromiso centromedular y anterior en proyecci\u00f3n D4-D5, D6-D7, D7-D8 y D9. Discreta dilataci\u00f3n del canal del ep\u00e9ndimo de la m\u00e9dula dorsal inferior.<\/p>\n [\/et_pb_text][et_pb_image src=\u00bbhttps:\/\/villavicencio.org.ar\/anuario\/wp-content\/uploads\/2025\/05\/Parestesias-1B.jpg\u00bb title_text=\u00bbParestesias 1B\u00bb align=\u00bbcenter\u00bb _builder_version=\u00bb4.27.4″ _module_preset=\u00bbdefault\u00bb global_colors_info=\u00bb{}\u00bb][\/et_pb_image][\/et_pb_column][\/et_pb_row][et_pb_row custom_padding_last_edited=\u00bbon|phone\u00bb _builder_version=\u00bb4.16″ background_color=\u00bb#ffffff\u00bb max_width=\u00bb1280px\u00bb custom_padding=\u00bb12px|40px|12px|40px|true|false\u00bb custom_padding_tablet=\u00bb\u00bb custom_padding_phone=\u00bb|20px||20px||true\u00bb animation_style=\u00bbzoom\u00bb animation_intensity_zoom=\u00bb2%\u00bb border_radii=\u00bbon|12px|12px|12px|12px\u00bb box_shadow_style=\u00bbpreset1″ box_shadow_vertical=\u00bb50px\u00bb box_shadow_blur=\u00bb80px\u00bb box_shadow_color=\u00bbrgba(15,19,25,0.1)\u00bb use_custom_width=\u00bbon\u00bb custom_width_px=\u00bb1280px\u00bb global_colors_info=\u00bb{}\u00bb][et_pb_column type=\u00bb4_4″ _builder_version=\u00bb4.16″ custom_padding=\u00bb|||\u00bb global_colors_info=\u00bb{}\u00bb custom_padding__hover=\u00bb|||\u00bb][et_pb_text _builder_version=\u00bb4.27.4″ text_font=\u00bb||||||||\u00bb text_font_size=\u00bb15px\u00bb text_line_height=\u00bb2em\u00bb header_font=\u00bb||||||||\u00bb header_2_font=\u00bb||||||||\u00bb header_3_font=\u00bbEB Garamond||||||||\u00bb header_3_font_size=\u00bb24px\u00bb header_3_line_height=\u00bb1.4em\u00bb header_4_font=\u00bb|700||on|||||\u00bb header_4_text_color=\u00bb#ffdaa4″ header_4_font_size=\u00bb12px\u00bb header_4_letter_spacing=\u00bb2px\u00bb header_4_line_height=\u00bb2em\u00bb text_line_height_tablet=\u00bb\u00bb text_line_height_phone=\u00bb1.6em\u00bb text_line_height_last_edited=\u00bbon|phone\u00bb locked=\u00bboff\u00bb global_colors_info=\u00bb{}\u00bb]<\/p>\n Figura 2: <\/strong>Resonancia magn\u00e9tica de cr\u00e1neo y \u00f3rbitas con contraste<\/p>\n No se observan alteraciones.<\/p>\n [\/et_pb_text][et_pb_image src=\u00bbhttps:\/\/villavicencio.org.ar\/anuario\/wp-content\/uploads\/2025\/05\/Parestesias-2.jpg\u00bb title_text=\u00bbParestesias 2″ align=\u00bbcenter\u00bb _builder_version=\u00bb4.27.4″ _module_preset=\u00bbdefault\u00bb global_colors_info=\u00bb{}\u00bb][\/et_pb_image][\/et_pb_column][\/et_pb_row][et_pb_row custom_padding_last_edited=\u00bbon|phone\u00bb _builder_version=\u00bb4.16″ background_color=\u00bb#ffffff\u00bb max_width=\u00bb1280px\u00bb custom_padding=\u00bb12px|40px|12px|40px|true|false\u00bb custom_padding_tablet=\u00bb\u00bb custom_padding_phone=\u00bb|20px||20px||true\u00bb animation_style=\u00bbzoom\u00bb animation_intensity_zoom=\u00bb2%\u00bb border_radii=\u00bbon|12px|12px|12px|12px\u00bb box_shadow_style=\u00bbpreset1″ box_shadow_vertical=\u00bb50px\u00bb box_shadow_blur=\u00bb80px\u00bb box_shadow_color=\u00bbrgba(15,19,25,0.1)\u00bb use_custom_width=\u00bbon\u00bb custom_width_px=\u00bb1280px\u00bb global_colors_info=\u00bb{}\u00bb][et_pb_column type=\u00bb4_4″ _builder_version=\u00bb4.16″ custom_padding=\u00bb|||\u00bb global_colors_info=\u00bb{}\u00bb custom_padding__hover=\u00bb|||\u00bb][et_pb_text _builder_version=\u00bb4.27.4″ text_font=\u00bb||||||||\u00bb text_font_size=\u00bb15px\u00bb text_line_height=\u00bb2em\u00bb header_font=\u00bb||||||||\u00bb header_2_font=\u00bb||||||||\u00bb header_3_font=\u00bbEB Garamond||||||||\u00bb header_3_font_size=\u00bb24px\u00bb header_3_line_height=\u00bb1.4em\u00bb header_4_font=\u00bb|700||on|||||\u00bb header_4_text_color=\u00bb#ffdaa4″ header_4_font_size=\u00bb12px\u00bb header_4_letter_spacing=\u00bb2px\u00bb header_4_line_height=\u00bb2em\u00bb text_line_height_tablet=\u00bb\u00bb text_line_height_phone=\u00bb1.6em\u00bb text_line_height_last_edited=\u00bbon|phone\u00bb locked=\u00bboff\u00bb global_colors_info=\u00bb{}\u00bb]<\/p>\n [\/et_pb_text][et_pb_image src=\u00bbhttps:\/\/villavicencio.org.ar\/anuario\/wp-content\/uploads\/2025\/05\/Parestesias-3.jpg\u00bb title_text=\u00bbParestesias 3″ align=\u00bbcenter\u00bb _builder_version=\u00bb4.27.4″ _module_preset=\u00bbdefault\u00bb global_colors_info=\u00bb{}\u00bb][\/et_pb_image][et_pb_text _builder_version=\u00bb4.27.4″ text_font=\u00bb||||||||\u00bb text_font_size=\u00bb15px\u00bb text_line_height=\u00bb2em\u00bb header_font=\u00bb||||||||\u00bb header_2_font=\u00bb||||||||\u00bb header_3_font=\u00bbEB Garamond||||||||\u00bb header_3_font_size=\u00bb24px\u00bb header_3_line_height=\u00bb1.4em\u00bb header_4_font=\u00bb|700||on|||||\u00bb header_4_text_color=\u00bb#ffdaa4″ header_4_font_size=\u00bb12px\u00bb header_4_letter_spacing=\u00bb2px\u00bb header_4_line_height=\u00bb2em\u00bb text_line_height_tablet=\u00bb\u00bb text_line_height_phone=\u00bb1.6em\u00bb text_line_height_last_edited=\u00bbon|phone\u00bb locked=\u00bboff\u00bb global_colors_info=\u00bb{}\u00bb]<\/p>\n Se siguen evidenciando las mismas hiperintensidades ya descriptas.<\/p>\n [\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row custom_padding_last_edited=\u00bbon|phone\u00bb _builder_version=\u00bb4.16″ background_color=\u00bb#ffffff\u00bb max_width=\u00bb1280px\u00bb custom_padding=\u00bb12px|40px|12px|40px|true|false\u00bb custom_padding_tablet=\u00bb\u00bb custom_padding_phone=\u00bb|20px||20px||true\u00bb animation_style=\u00bbzoom\u00bb animation_intensity_zoom=\u00bb2%\u00bb border_radii=\u00bbon|12px|12px|12px|12px\u00bb box_shadow_style=\u00bbpreset1″ box_shadow_vertical=\u00bb50px\u00bb box_shadow_blur=\u00bb80px\u00bb box_shadow_color=\u00bbrgba(15,19,25,0.1)\u00bb use_custom_width=\u00bbon\u00bb custom_width_px=\u00bb1280px\u00bb global_colors_info=\u00bb{}\u00bb][et_pb_column type=\u00bb4_4″ _builder_version=\u00bb4.16″ custom_padding=\u00bb|||\u00bb global_colors_info=\u00bb{}\u00bb custom_padding__hover=\u00bb|||\u00bb][et_pb_text _builder_version=\u00bb4.27.4″ text_font=\u00bb||||||||\u00bb text_font_size=\u00bb15px\u00bb text_line_height=\u00bb2em\u00bb header_font=\u00bb||||||||\u00bb header_2_font=\u00bb||||||||\u00bb header_3_font=\u00bbEB Garamond||||||||\u00bb header_3_font_size=\u00bb24px\u00bb header_3_line_height=\u00bb1.4em\u00bb header_4_font=\u00bb|700||on|||||\u00bb header_4_text_color=\u00bb#ffdaa4″ header_4_font_size=\u00bb12px\u00bb header_4_letter_spacing=\u00bb2px\u00bb header_4_line_height=\u00bb2em\u00bb text_line_height_tablet=\u00bb\u00bb text_line_height_phone=\u00bb1.6em\u00bb text_line_height_last_edited=\u00bbon|phone\u00bb locked=\u00bboff\u00bb global_colors_info=\u00bb{}\u00bb]<\/p>\n Figura 4:<\/strong> Tomograf\u00eda de t\u00f3rax<\/p>\n [\/et_pb_text][et_pb_image src=\u00bbhttps:\/\/villavicencio.org.ar\/anuario\/wp-content\/uploads\/2025\/05\/Parestesias-4.jpg\u00bb title_text=\u00bbParestesias 4″ align=\u00bbcenter\u00bb _builder_version=\u00bb4.27.4″ _module_preset=\u00bbdefault\u00bb global_colors_info=\u00bb{}\u00bb][\/et_pb_image][et_pb_text _builder_version=\u00bb4.27.4″ text_font=\u00bb||||||||\u00bb text_font_size=\u00bb15px\u00bb text_line_height=\u00bb2em\u00bb header_font=\u00bb||||||||\u00bb header_2_font=\u00bb||||||||\u00bb header_3_font=\u00bbEB Garamond||||||||\u00bb header_3_font_size=\u00bb24px\u00bb header_3_line_height=\u00bb1.4em\u00bb header_4_font=\u00bb|700||on|||||\u00bb header_4_text_color=\u00bb#ffdaa4″ header_4_font_size=\u00bb12px\u00bb header_4_letter_spacing=\u00bb2px\u00bb header_4_line_height=\u00bb2em\u00bb text_line_height_tablet=\u00bb\u00bb text_line_height_phone=\u00bb1.6em\u00bb text_line_height_last_edited=\u00bbon|phone\u00bb locked=\u00bboff\u00bb global_colors_info=\u00bb{}\u00bb]<\/p>\n Se observan adenomegalias mediastinales.<\/p>\n [\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row custom_padding_last_edited=\u00bbon|phone\u00bb _builder_version=\u00bb4.16″ background_color=\u00bb#ffffff\u00bb max_width=\u00bb1280px\u00bb custom_padding=\u00bb12px|40px|12px|40px|true|false\u00bb custom_padding_tablet=\u00bb\u00bb custom_padding_phone=\u00bb|20px||20px||true\u00bb animation_style=\u00bbzoom\u00bb animation_intensity_zoom=\u00bb2%\u00bb border_radii=\u00bbon|12px|12px|12px|12px\u00bb box_shadow_style=\u00bbpreset1″ box_shadow_vertical=\u00bb50px\u00bb box_shadow_blur=\u00bb80px\u00bb box_shadow_color=\u00bbrgba(15,19,25,0.1)\u00bb use_custom_width=\u00bbon\u00bb custom_width_px=\u00bb1280px\u00bb global_colors_info=\u00bb{}\u00bb][et_pb_column type=\u00bb4_4″ _builder_version=\u00bb4.16″ custom_padding=\u00bb|||\u00bb global_colors_info=\u00bb{}\u00bb custom_padding__hover=\u00bb|||\u00bb][et_pb_text _builder_version=\u00bb4.27.4″ text_font=\u00bb||||||||\u00bb text_font_size=\u00bb15px\u00bb text_line_height=\u00bb2em\u00bb header_font=\u00bb||||||||\u00bb header_2_font=\u00bb||||||||\u00bb header_3_font=\u00bbEB Garamond||||||||\u00bb header_3_font_size=\u00bb24px\u00bb header_3_line_height=\u00bb1.4em\u00bb header_4_font=\u00bb|700||on|||||\u00bb header_4_text_color=\u00bb#ffdaa4″ header_4_font_size=\u00bb12px\u00bb header_4_letter_spacing=\u00bb2px\u00bb header_4_line_height=\u00bb2em\u00bb text_line_height_tablet=\u00bb\u00bb text_line_height_phone=\u00bb1.6em\u00bb text_line_height_last_edited=\u00bbon|phone\u00bb locked=\u00bboff\u00bb global_colors_info=\u00bb{}\u00bb]<\/p>\n [\/et_pb_text][et_pb_image src=\u00bbhttps:\/\/villavicencio.org.ar\/anuario\/wp-content\/uploads\/2025\/05\/Parestesias-5.jpg\u00bb title_text=\u00bbParestesias 5″ align=\u00bbcenter\u00bb _builder_version=\u00bb4.27.4″ _module_preset=\u00bbdefault\u00bb global_colors_info=\u00bb{}\u00bb][\/et_pb_image][et_pb_text _builder_version=\u00bb4.27.4″ text_font=\u00bb||||||||\u00bb text_font_size=\u00bb15px\u00bb text_line_height=\u00bb2em\u00bb header_font=\u00bb||||||||\u00bb header_2_font=\u00bb||||||||\u00bb header_3_font=\u00bbEB Garamond||||||||\u00bb header_3_font_size=\u00bb24px\u00bb header_3_line_height=\u00bb1.4em\u00bb header_4_font=\u00bb|700||on|||||\u00bb header_4_text_color=\u00bb#ffdaa4″ header_4_font_size=\u00bb12px\u00bb header_4_letter_spacing=\u00bb2px\u00bb header_4_line_height=\u00bb2em\u00bb text_line_height_tablet=\u00bb\u00bb text_line_height_phone=\u00bb1.6em\u00bb text_line_height_last_edited=\u00bbon|phone\u00bb locked=\u00bboff\u00bb global_colors_info=\u00bb{}\u00bb]<\/p>\n Se observa marcada regresi\u00f3n de la alteraci\u00f3n de se\u00f1al.\u200b<\/p>\n [\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=\u00bb1″ admin_label=\u00bbCourses\u00bb _builder_version=\u00bb4.16″ custom_padding=\u00bb1px|0px|62px|0px|false|false\u00bb collapsed=\u00bboff\u00bb global_colors_info=\u00bb{}\u00bb][et_pb_row custom_padding_last_edited=\u00bbon|phone\u00bb _builder_version=\u00bb4.17.4″ background_color=\u00bb#ffffff\u00bb max_width=\u00bb1280px\u00bb custom_padding=\u00bb12px|40px|12px|40px|true|false\u00bb custom_padding_tablet=\u00bb\u00bb custom_padding_phone=\u00bb|20px||20px||true\u00bb animation_style=\u00bbzoom\u00bb animation_intensity_zoom=\u00bb2%\u00bb border_radii=\u00bbon|12px|12px|12px|12px\u00bb box_shadow_style=\u00bbpreset1″ box_shadow_vertical=\u00bb50px\u00bb box_shadow_blur=\u00bb80px\u00bb box_shadow_color=\u00bbrgba(15,19,25,0.1)\u00bb use_custom_width=\u00bbon\u00bb custom_width_px=\u00bb1280px\u00bb global_colors_info=\u00bb{}\u00bb][et_pb_column type=\u00bb4_4″ _builder_version=\u00bb4.16″ custom_padding=\u00bb|||\u00bb global_colors_info=\u00bb{}\u00bb custom_padding__hover=\u00bb|||\u00bb][et_pb_text _builder_version=\u00bb4.27.4″ text_font=\u00bb||||||||\u00bb text_font_size=\u00bb12px\u00bb text_line_height=\u00bb2em\u00bb header_font=\u00bb||||||||\u00bb header_2_font=\u00bb||||||||\u00bb header_3_font=\u00bbEB Garamond||||||||\u00bb header_3_font_size=\u00bb24px\u00bb header_3_line_height=\u00bb1.4em\u00bb header_4_font=\u00bb|700||on|||||\u00bb header_4_text_color=\u00bb#ffdaa4″ header_4_font_size=\u00bb12px\u00bb header_4_letter_spacing=\u00bb2px\u00bb header_4_line_height=\u00bb2em\u00bb text_line_height_tablet=\u00bb\u00bb text_line_height_phone=\u00bb1.6em\u00bb text_line_height_last_edited=\u00bbon|phone\u00bb locked=\u00bboff\u00bb global_colors_info=\u00bb{}\u00bb] 1.\tKidd DP. Neurosarcoidosis: clinical manifestations, investigation and treatment. Pract Neurol. 2020;20:199-212. Disponible en: https:\/\/doi.org\/10.1136\/practneurol-2019-002349 La sarcoidosis es un trastorno inmunitario multisist\u00e9mico que se puede manifestar en diferentes \u00f3rganos y sistemas y afecta al sistema nervioso solo en el 10 % de los casos.
Sanatorio Parque, Bv. Oro\u00f1o 860 (2000) Rosario, Argentina
Correspondencia a<\/strong>: milivaldez4@gmail.com
Fecha de publicaci\u00f3n<\/strong>: 06\/05\/2025<\/p>\nResumen<\/h3>\n
Puede comprometer tanto el sistema nervioso central como perif\u00e9rico en diversos grados y es el diagn\u00f3stico diferencial de m\u00faltiples enfermedades inflamatorias infecciosas, inmunol\u00f3gicas, neopl\u00e1sicas y degenerativas.
El curso cl\u00ednico de la neurosarcoidosis espinal puede imitar una enfermedad desmielinizante. Se requiere un alto \u00edndice de sospecha y una b\u00fasqueda de sarcoidosis en sitios extraneurales para un diagn\u00f3stico temprano.
La base del diagn\u00f3stico es la histolog\u00eda, por eso, muchas veces representa un reto llegar al mismo.
El tratamiento con corticoides generalmente se asocia con un resultado favorable.
En este art\u00edculo se describe el caso de un paciente que comenz\u00f3 con un cuadro subagudo de parestesias, con el cual fue bastante dificultoso llegar al diagn\u00f3stico, pero afortunadamente se logr\u00f3 y hubo una muy buena respuesta al tratamiento con corticoides.<\/p>\nPalabras clave<\/h3>\n
T\u00edtulo en ingl\u00e9s<\/h3>\n
Patient with Paresthesias: A Diagnostic Challenge.
\n<\/strong><\/h2>\nAbstract<\/h3>\n
It can involve both the central and peripheral nervous system to varying degrees, and it is a differential diagnosis for multiple inflammatory, infectious, immunological, neoplastic, and degenerative diseases.
The clinical course of spinal neurosarcoidosis can mimic a demyelinating disease. A high index of suspicion and a search for sarcoidosis in extraneural sites are required for early diagnosis. The basis for diagnosis is histology, which often represents a challenge.<\/p>\n
This article describes the case of a patient who started with subacute paresthesias being the diagnosis quite difficult to reach, but fortunately once it was achieved, there was a very good response to corticosteroid treatment.<\/p>\nKeywords<\/h3>\n
Introducci\u00f3n<\/h3>\n
Por lo general comienza de manera subaguda con s\u00edntomas constitucionales como fiebre, diaforesis, malestar general, sudoraci\u00f3n nocturna.1<\/sup>
Luego, se hacen evidentes los s\u00edntomas del \u00f3rgano afectado:
– Neuropat\u00edas craneales (par\u00e1lisis facial, neuropat\u00eda \u00f3ptica, diplop\u00eda, v\u00e9rtigo, hipoacusia)
– Neuropat\u00edas perif\u00e9ricas (sensitivas, motoras, auton\u00f3micas)
– Compromiso hipofisario-hipotal\u00e1mico (diabetes ins\u00edpida, d\u00e9ficit de gonadotrofinas, tirotropina, insuficiencia cortico-adrenal.)
– Compromiso de la m\u00e9dula espinal: Mielopat\u00eda subaguda (mielopat\u00eda longitudinalmente extensa)
Aunque, en la neurosarcoidosis, el compromiso subcl\u00ednico del sistema nervioso central es lo m\u00e1s com\u00fan, s\u00edntomas cl\u00ednicos evidentes se observan solo en el 15 % de los casos y, entre el 6 y el 8 % de estos pacientes tienen compromiso de la m\u00e9dula espinal.2<\/sup>
El diagn\u00f3stico se establece con:
– Estudios por im\u00e1genes (resonancia magn\u00e9tica con contraste, Tomograf\u00eda por emisi\u00f3n de positrones 18FDG)
– An\u00e1lisis del l\u00edquido Cefalorraqu\u00eddeo (LCR) (c\u00e9lulas, prote\u00ednas, glucosa)
– Biopsia histol\u00f3gica3<\/sup>
Hay que tener en cuenta que existe una gran lista de condiciones que pueden simular las caracter\u00edsticas cl\u00ednicas y de imagen de la neurosarcoidosis, adem\u00e1s, una enfermedad neopl\u00e1sica o infecciosa puede iniciar como una enfermedad granulomatosa.
Por esto, es realmente dif\u00edcil llegar al diagn\u00f3stico, y la base de \u00e9ste es la biopsia histol\u00f3gica.4<\/sup>
El tratamiento se basa en corticosteroides (prednisona) e inmunosupresores (metotrexato, micofenolato mofetilo, azatioprina, ciclofosfamida).
Es importante mencionar que no hay cura conocida para la sarcoidosis, pero con tratamiento, muchos pacientes pueden experimentar una mejora significativa en sus s\u00edntomas. La respuesta al tratamiento puede variar dependiendo de la gravedad de la enfermedad y la afectaci\u00f3n de otros \u00f3rganos.<\/p>\nObjetivos<\/h3>\n
\n
Presentaci\u00f3n del caso<\/h3>\n
Se le realiz\u00f3 un examen neurol\u00f3gico donde se lo encontr\u00f3 vigil, orientado, con lenguaje conservado. Pares craneales, reflejos, sensibilidad t\u00e1ctil superficial y vibratoria conservados. Fuerza y tono conservados en los 4 miembros. Marcha sin alteraciones.
Presentaba dificultad en la micci\u00f3n.
L\u00edquido cefalorraqu\u00eddeo: 20 elementos, 80 % mononucleares.
Se decidi\u00f3 realizarle una resonancia magn\u00e9tica de columna cervical, dorsal y lumbosacra donde se pudo visualizar a nivel dorsal una extensa alteraci\u00f3n de la se\u00f1al del cord\u00f3n medular siendo hiperintenso en T2 de D2 a D10 inclusive. Realce intenso de aspecto parcheado con mayor compromiso centromedular y anterior en proyecci\u00f3n D4-D5, D6-D7, D7-D8 y D9. Discreta dilataci\u00f3n del canal del ep\u00e9ndimo de la m\u00e9dula dorsal inferior (Figuras 1-a y 1-b).
Se interpret\u00f3 como una etiolog\u00eda inflamatoria, se decidi\u00f3 internaci\u00f3n y se solicit\u00f3 una resonancia magn\u00e9tica de cr\u00e1neo y \u00f3rbitas con contraste para completar el estudio, la cual no evidenci\u00f3 alteraciones (Figura 2).
Diagn\u00f3stico: Mielitis longitudinalmente extensa
Se le realiz\u00f3 tratamiento con pulsos de meprednisona 1 gr\/d\u00eda durante 5 d\u00edas con muy buena respuesta, persistiendo ciertos s\u00edntomas sensitivos, pero de menor jerarqu\u00eda. Luego se decidi\u00f3 el alta sanatorial.
Al mes se le realiz\u00f3 resonancia magn\u00e9tica de control, como resultado la resonancia magn\u00e9tica de cr\u00e1neo fue normal, la de columna sigui\u00f3 evidenciando las mismas hiperintensidades ya descriptas (Figura 3).
Se indicaron pulsos de 1 gramo por d\u00eda de metilprednisolona por 5 d\u00edas.
Dos meses m\u00e1s tarde el paciente reingres\u00f3 por tos y disnea por lo que se decidi\u00f3 realizarle una tomograf\u00eda de t\u00f3rax con contraste en la cual se evidenci\u00f3 un marcado engrosamiento de los tejidos blandos peribroncovasculares que compromet\u00eda el hemit\u00f3rax izquierdo a nivel peri e infra hiliar. Adenopat\u00edas e infiltraci\u00f3n difusa (Figura 4).
Los diagn\u00f3sticos diferenciales que se plantearon fueron: desmielinizante, tumoral, infecciosa, postinfecciosa, isquemia, compresiva, paraneoplasia.
Se sugiri\u00f3 continuar con otra metodolog\u00eda diagn\u00f3stica, por lo cual se le realiz\u00f3 una biopsia de ganglios tor\u00e1cicos y se lleg\u00f3 al diagn\u00f3stico de sarcoidosis. Se indic\u00f3 como tratamiento: pregabalina 37,5 mg cada 12 h, \u00e1cido f\u00f3lico, deltisona 14 mg, metotrexato15 mg, apixaban 5 mg.
La resonancia magn\u00e9tica de control al mes mostr\u00f3 marcada regresi\u00f3n de la alteraci\u00f3n de se\u00f1al descripta previamente en m\u00e9dula dorsal extendida desde D2 a D9, as\u00ed como tambi\u00e9n de las \u00e1reas de realce en dicha topograf\u00eda (Figura 5).<\/p>\nDiscusi\u00f3n<\/h3>\n
La necesidad de un alto \u00edndice de sospecha y la b\u00fasqueda de sarcoidosis en sitios extraneurales son cruciales para un diagn\u00f3stico temprano. La confirmaci\u00f3n diagn\u00f3stica mediante histolog\u00eda, aunque esencial, puede ser dif\u00edcil de obtener debido a la naturaleza invasiva de los procedimientos necesarios para obtener muestras adecuadas.
El tratamiento con corticoides ha demostrado ser eficaz en la mayor\u00eda de los casos, como se observa en este paciente, quien mostr\u00f3 una notable mejor\u00eda tras el inicio del tratamiento. Este resultado positivo refuerza la importancia de considerar la sarcoidosis en el diagn\u00f3stico diferencial de enfermedades neurol\u00f3gicas inflamatorias y de iniciar un tratamiento temprano con corticoides para mejorar los resultados cl\u00ednicos.<\/p>\nConclusiones<\/h3>\n
Conflicto de intereses<\/h3>\n
Figura 3:<\/strong> Primer control de resonancia magn\u00e9tica de columna total<\/p>\n
Figura 5: <\/strong>Segundo control de resonancia magn\u00e9tica de columna total<\/p>\n
\n 2.\tBasheer M, Waked H, Jeries H, et al. Neurosarcoidosis: the presentation, diagnosis and treatment review of two cases. Life (Basel). 2023;14:69. Disponible en: https:\/\/doi.org\/10.3390\/life14010069
\n 3.\tKasliwal MK, Harbhajanka A, Nag S, et al. Isolated spinal neurosarcoidosis: An enigmatic intramedullary spinal cord pathology-case report and review of the literature. J Craniovertebr Junction Spine. 2013;4:76-81. Disponible en: https:\/\/doi.org\/10.4103\/0974-8237.128536
\n 4.\tKumar N, Frohman EM. Spinal neurosarcoidosis mimicking an idiopathic inflammatory demyelinating syndrome. Arch Neurol. 2004;61:586-589. Disponible en: https:\/\/doi.org\/10.1001\/archneur.61.4.586[\/et_pb_text][et_pb_text _builder_version=\u00bb4.24.2″ text_font=\u00bb||||||||\u00bb text_font_size=\u00bb15px\u00bb text_line_height=\u00bb2em\u00bb header_font=\u00bb||||||||\u00bb header_2_font=\u00bb||||||||\u00bb header_3_font=\u00bbEB Garamond||||||||\u00bb header_3_font_size=\u00bb24px\u00bb header_3_line_height=\u00bb1.4em\u00bb header_4_font=\u00bb|700||on|||||\u00bb header_4_text_color=\u00bb#ffdaa4″ header_4_font_size=\u00bb12px\u00bb header_4_letter_spacing=\u00bb2px\u00bb header_4_line_height=\u00bb2em\u00bb text_line_height_tablet=\u00bb\u00bb text_line_height_phone=\u00bb1.6em\u00bb text_line_height_last_edited=\u00bbon|phone\u00bb global_colors_info=\u00bb{}\u00bb][\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section]<\/p>\n","protected":false},"excerpt":{"rendered":"
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