Femoral artery injury during aneurysm coiling

http://dx.doi.org/10.1590/0100-3984.2014.0113 toms of diabetes insipidus such as polydipsia and polyuria may also occur due to the involvement of the hypothalamus and hypophysis. In cases of spinal cord involvement, weakness of lower limbs and other nonspecific signs of myelopathy are observed. Although sarcoidosis may manifest in all the regions of the central nervous system, it is most commonly seen in the skull base, hypothalamus, pituitary and optic chiasm. At magnetic resonance imaging, a common finding is intraparenchymal lesions with hypersignal on T2-weighted and FLAIR sequences, generally multifocal, periventricular, subcortical or in the deep white matter. Such findings can hardly be differentiated from vasculitis or demyelinating diseases. Intraparenchymal lesions are generally located near the areas with leptomeningeal involvement (with enhancement by paramagnetic contrast medium), and may be either single or multiple, possibly also involving cranial nerves. Like in the present case, diffuse pachymeningeal thickening may be observed, with hyposignal on T2-weighted, isosignal on T1-weighted sequences and contrast enhancement. Thus, differential diagnoses such as neurotuberculosis, dural lymphoma, meningioma en plaque, IgG4 deposition disease, pseudotumor, adenocarcinoma metastasis, Wegener’s granulomatosis, idiopathic hypertrophic pachymeningitis might be considered, requiring biopsy to define the etiology. Simultaneous dural and leptomeningeal involvement is rarely observed. In the present case, the anatomopathological findings corresponded to typical noncaseating granulomas in the pachymeninges (Figure 2). Intracranial hypotension is another differential diagnosis to be considered, generally presenting with diffuse pachymeningeal thickening, but with hypersignal on T2-weighted sequences (in the present case, hyposignal was observed on T2-weighted sequences). A consensus is still to be reached on the treatment for sarcoidosis. In cases where the patient is symptomatic the treatment is initiated with high doses of corticosteroids, gradually reduced along the treatment up to complete withdrawal.