Trigger autoimmunity -development of multiple plexopathy in a patient with chronic idiopathic thrombocytopenic purpura.

CMYK 281 cornerstone of the therapy for neurosarcoidosis. Steroid therapy is usually started at a high dose and after achieving a clinical response, the dose is gradually tapered. Alternative therapeutic agents are indicated in patients with steroid sideeffects or lack of response to treatment or in cases where steroids are contraindicated. These include cyclosporine, azathioprine, hydroxychloroquine, chloroquine and radiation therapy. Chloroquine and hydroxychloroquine have been found to be effective in controlling neurosarcoidosis in patients who fail to respond to corticosteroids or develop serious side-effects, with no evidence of ocular toxicity during the treatment. Clinical manifestations are the best predictors of the course and prognosis in patients with neurosarcoidosis. Cranial neuropathies and aseptic meningitis carry the best prognosis with recovery in up to 90% of cases. Approximately 32% of the patients with neurosarcoidosis, especially those with cranial neuropathies, relapse after the initial neurological episode. Patients with parenchymal disease generally have a prolonged disease course with significant morbidity. Among the peripheral nervous system manifestations, polyradiculitis and acute myopathy tend to respond well to steroids compared to the slowly progressive peripheral neuropathy and myopathy.