PMC6109485_01
Head MRI showing thickening of the floor of the third ventricle and lesions in the arachnoid and pia membranes (arrows).
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Thus, neurosarcoidosis was suspected (Figure 1); however, levels of serum angiotensin-converting enzyme and soluble interleukin-2 receptor were not elevated.
Head CT images at hospital admission (a) and on day 16 (b). The lateral ventricle on day 16 is larger than that at hospital admission.
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On day 16, the patient suddenly exhibited impaired consciousness; head computed tomography (CT) showed ventricular enlargement, and she was therefore diagnosed with acute hydrocephalus (Figure 2).
Head MRI showing contrast-enhanced nodular lesions on the floor of the third ventricle, aqueduct of the midbrain, and fourth ventricle.
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Ventricular drainage led to improved consciousness, and contrast-enhanced head MRI confirmed nodular lesions with contrast effects in the floor of the third ventricle, cerebral aqueduct, and fourth ventricle (Figure 3).
Hematoxylin and eosin-stained sections of nodular lesions on the floor of the third ventricle. Noncaseating epithelioid cell granulomas are observed (arrows).
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Histopathological examination showed noncaseating epithelioid cell granulomas (Figure 4).
Clinical course from the day of hospital admission. The serum sodium level improved after initiation of steroid therapy. SIADH: syndrome of inappropriate secretion of antidiuretic hormone; mPSL: methylprednisolone; PSL: prednisolone; Na: sodium.
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On day 70 of the illness, the patient was discharged on the basis of her independent gait (Figure 5).