Presse Med
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Sarcoidosis is an idiopathic granulomatous disease affecting multiple organs. Neurosarcoidosis, involving the central and/or peripheral nervous systems, is a relatively rare form of sarcoidosis. Its clinical manifestations include cranial neuropathies, meningitis, neuroendocrinological dysfunction, hydrocephalus, seizures, neuropsychiatric symptoms, myelopathy and neuropathies. ⋯ Although biopsy of neural tissue is the gold standard for the diagnosis of neurosarcoidosis, this is often not practical and the diagnosis must be inferred though other tests, often coupled with biopsy of extraneural organs. Corticosteroids and other immuno-suppressants are frequently used for the treatment of neurosarcoidosis. This article reviews the epidemiology, pathogenesis, pathology, clinical features, diagnosis, diagnostic tests, diagnostic criteria, and therapy of neurosarcoidosis.
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Diagnosis of small fiber neuropathy may be challenging due to subtle clinical signs and to the normality of nerve conduction studies. Skin biopsy is a non invasive method which allows to quantify intraepidermal nerve fiber density after a simple immunostaining. ⋯ When the diagnosis of small fiber neuropathy has been made by means of skin biopsy, possibly combined with laser evoked potentials, a diagnostic work up has to be done in order to find one of the classical causes of this disorder. To date, skin biopsy is useful to confirm the diagnosis of small fiber neuropathy but lacks utility to find its etiology.