Intradural Extramedullary Spinal Sarcoidosis Mimicking Meningioma

Abstract

Background. Spinal sarcoidosis is a rare subgroup of neurosarcoidosis. Although most sarcoid lesions develop in the intramedullary compartment, intradural extramedullary (IDEM) spinal sarcoidosis is an extremely rare entity. Case Presentation. We herein report a case of IDEM spinal sarcoidosis mimicking a meningioma. A 32-year-old man presented to the hospital with clumsy hands and was unable to walk without assistance. Magnetic resonance imaging (MRI) of the cervical spine revealed a dural tail sign that is common in meningiomas. The patient underwent gross total resection. The pathological findings consisted with a sarcoid leision of the spinal cord. The patient’s myelopathy recovered after surgery. Conclusions. Physicians should be alert for the possibility of IDEM sarcoidosis mimicking a meningioma in the differential diagnosis of IDEM spinal cord tumors.

Hydrocephalus and myelopathy: A rare and challenging case of sarcoidosis and review of literature

“…On review of literature, there are few cases of NS presented with either myelopathy or hydrocephalus before a diagnosis of sarcoidosis was made, but no case reported with both myelopathy and hydrocephalus as isolated presentations of NS and without a previous diagnosis of sarcoidosis. [4][5][6]8,14 Our case was similar to the other reported cases regarding the presenting manifestations of weakness and/or sensory symptoms of extremities in the setting of myelopathy as well as headache and/or confusion in the setting of hydrocephalus in the absence of evident systemic disease. However, the response to treatment in each case was variable.…”

“…4 Hydrocephalus and spinal cord involvement are the rarest presentations of NS. 3,4 Hydrocephalus, either communicating or noncommunicating, has been noted in 6%-9% of cases of NS, 4,5 while spinal cord involvement occurs in approximately 6%-8% of NS cases 6 and occurring in <1% of all sarcoidosis cases. 3 The clinical presentations of NS can be very broad and atypical, which makes the diagnosis of such disease exceedingly challenging especially in previously healthy individuals who come with hydrocephalus and/or myelopathy as initial manifestations without other evident symptoms of sarcoidosis.…”

“…Hydrocephalus and spinal cord involvement are the rarest presentations of NS 3,4 . Hydrocephalus, either communicating or noncommunicating, has been noted in 6%‐9% of cases of NS, 4,5 while spinal cord involvement occurs in approximately 6%‐8% of NS cases 6 and occurring in <1% of all sarcoidosis cases 3 …”

Recurrence of Epidural Spinal Sarcoidosis

“… 22 , 26 Sarcoidosis has been described to manifest both in the vertebral bodies and within the spinal canal. 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 Those with intraspinal presentation are almost exclusively intradural sarcoidosis. 13 14 15 16 17 18 19 20 21 To the best of our knowledge, there are nine reported cases of intraspinal epidural sarcoidosis in the literature, including ours (Table 1 ).…”

“… 2 3 4 5 6 7 8 9 10 11 12 However, cases of intraspinal sarcoidosis have been reported but are almost exclusively that of intradural spinal cord disease. 13 14 15 16 17 18 19 There are eight reported cases of intraspinal epidural sarcoidosis published. 20 21 22 23 24 25 26 27 Most cases present in the thoracic spine 20 , 21 , 23 24 25 26 with one reported case in the lumbar spine 27 and one in the cervical spine.…”