The clinical picture of neurosarcoidosis (NS) shares many aspects with multiple sclerosis (MS). I examine whether or not clinical measures can reliably distinguish NS mimicking MS from NS coexisting with MS, and the informative role biopsy and autopsy evidence may play in understanding these two disorders. Uniquely challenging, I explore the rare patients presenting with the differential of MS or acute disseminated encephalomyelitis (ADEM) versus NS, including MS or ADEM as an associated illness in patients with systemic sarcoidosis. In most but not all NS patients, red flags against a diagnosis of MS are strong enough to rule out this more common disorder. Biopsy and autopsy findings indicate a tendency of NS granulomatous changes in the CNS to involve the same deep white matter perivascular spaces as expected to occur in MS, and hence correlate with a tendency of NS involving white matter to produce classic MRI findings of MS. The spectrum of NS includes some cases limited to a single anatomical site, including sites classically involved in demyelinating CIS (optic nerve, brainstem, and transverse myelitis). Asymptomatic “non-specific” periventricular MRI changes are described in many studies as “MS-like”. No biopsied or autopsied cases have yet proven associated classic pathological changes of MS in patients with NS.

神经结节病 (NS) 的临床表现与多发性硬化症 (MS) 有许多相似之处。我检查了临床测量是否可以可靠地区分 NS 模拟 MS 和 NS 与 MS 共存，以及活检和尸检证据在理解这两种疾病方面可能发挥的信息作用。具有独特的挑战性，我探索了罕见的 MS 或急性播散性脑脊髓炎 (ADEM) 与 NS 的差异，包括 MS 或 ADEM 作为系统性结节病患者的相关疾病。在大多数但并非所有 NS 患者中，诊断 MS 的危险信号足以排除这种更常见的疾病。活检和尸检结果表明 CNS 中 NS 肉芽肿性变化的趋势与预期发生在 MS 中的深部白质血管周围间隙相同，因此与 NS 涉及白质的倾向相关，以产生 MS 的经典 MRI 结果。NS 的范围包括一些仅限于单个解剖部位的病例，包括经典的 CIS 脱髓鞘部位（视神经、脑干和横贯性脊髓炎）。无症状的“非特异性”脑室周围 MRI 改变在许多研究中被描述为“MS 样”。尚无活检或尸检病例证明 NS 患者与 MS 相关的典型病理变化。无症状的“非特异性”脑室周围 MRI 改变在许多研究中被描述为“MS 样”。尚无活检或尸检病例证明 NS 患者与 MS 相关的典型病理变化。无症状的“非特异性”脑室周围 MRI 改变在许多研究中被描述为“MS 样”。尚无活检或尸检病例证明 NS 患者与 MS 相关的典型病理变化。