Intramedullary cervical spinal cord sarcoidosis

Abstract

Study design: Case report. Objective: To report on an uncommon patient of cervical spinal cord sarcoidosis. Setting: New York, USA. Methods: A 47-year-old man was evaluated for heaviness of his legs, difficulty walking and numbness of arms and feet for 6 months. Contrast enhanced MRI scan showed a strongly enhancing nodular lesion, suggestive of a spinal cord tumor, which was initially considered for neurosurgical biopsy and treatment. Investigations unexpectedly revealed mediastinal lymphadenopathy and elevated angiotensin converting enzyme levels and the diagnosis of sarcoidosis was confirmed by a transbronchial lung biopsy. Result: Prompt treatment with steroids resulted in complete clinical and radiological resolution of the spinal cord lesion within 4 weeks. This improvement was maintained over a 18 month follow-up period. Conclusion: Isolated spinal cord intramedullary enhancing lesions, even when the appearance is suggestive of a tumor, should be rigorously investigated for sarcoidosis and a trial of steroid therapy considered to avoid unnecessary surgery.

Transverse Myelitis

“…130 Although unusual, spinal cord involvement portends a poor outcome, and may be related to intramedullary, intradural extramedullary, or extradural lesions; cauda equina syndrome; or arachnoiditis. 130,131,133 Although isolated myelopathy has been observed, half of patients with spinal cord neurosarcoidosis demonstrate systemic manifestations. 129,133,134 Neurosarcoidosis has a predilection for the cervical and thoracic cord 131,132,[135][136][137] and is frequently associated with back pain and radicular symptoms.…”

“…130,131,133 Although isolated myelopathy has been observed, half of patients with spinal cord neurosarcoidosis demonstrate systemic manifestations. 129,133,134 Neurosarcoidosis has a predilection for the cervical and thoracic cord 131,132,[135][136][137] and is frequently associated with back pain and radicular symptoms. 131,138-140 Table 5 Other dysimmune disorders associated with TM…”

Sarcoidosis of the Spine

“…Another plausible explanation is that the spinal cord was involved by the sarcoidosis but the changes were undetected with MRI. Abnormal MRI signal changes within the parenchyma of the spinal cord associated with sarcoidosis have been reported in other series 10,11 .…”

Intramedullary Cervical Sarcoidosis as the Initial Presentation of Systemic Sarcoidosis

“…Many articles show that cases of isolated spinal cord sarcoid (lack of systemic findings) range from 0.5-1% [ 6 , 8 ]. In a report by Bhagavati and Choi, involvement of the spinal cord was presumed in approximately 0.3-0.4% of cases which predominantly affected the cervical and thoracic spinal cord [ 1 ]. Their literature review established “intramedullary involvement in 35% of cases, extramedullary involvement in 35% of cases, and both [intra and extramedullary involvement] in 23% of patients”[ 1 ].…”