Intramedullary spinal sarcoidosis

Abstract

We present a retrospective series of the clinical and MRI findings in 16 patients with intramedullary spinal sarcoidosis (ISS), including 12 patients studied with gadolinium-DTPA. The spectrum of MRI findings includes leptomeningeal enhancement, fusiform spinal cord enlargement, focal or diffuse intramedullary disease, and spinal cord atrophy. We present a classification of ISS correlating the clinical progression and the temporal sequence of MRI abnormalities. Improvement occurred in five of 12 patients (42%) treated with immunosuppressive therapy.

Intramedullary spinal sarcoidosis: clinical improvement reflected in T-lymphocyte subpopulation ratios

“…Moreover, frozen section may not be reliable. 1 In our patient, a thorough search for other biopsy sites yielded a diagnosis.…”

“…Serial MR imaging depicts cord enhancement and enlargement evolving to eventual atrophy without enhancement in later stages. 1 Imaging in the midst of this process may portray an apparent normalization of the cord despite still-active disease. CSF sampling could provide objective laboratory evidence supporting clinical decline or resolution.…”

“…Cerebrospinal fluid (CSF) markers are insensitive and tissue biopsy carries significant morbidities. 1 In contrast, pulmonary sarcoidosis has characteristic immunocytologic changes in alveolar fluid. 2 Small studies suggest an elevated ratio of CSF CD4:CD8 þ (T helper:T suppressor or T4:T8) lymphocytes in neurosarcoidosis.…”

Isolated intramedullary neurosarcoidosis of the thoracic spine: case report and review of the literature

“…Since then, it has become a well-described manifestation of sarcoidosis. Spinal cord involvement is more prevalent in the cervical spine (56%) than in the thoracic (37%) and lumbosacral (7%) spine [16,17]. Spinal sarcoidosis can present with varied symptoms, including weakness, paresthesias, myelopathy, demyelinating syndrome [18], facial nerve paralysis [28], bowel, bladder, or sexual disturbances, back pain [10,26], or even radicular pain [30].…”

“…Central nervous system (CNS) involvement (neurosarcoidosis) occurs in 5-15% of cases, and 6-8% of patients with neurosarcoidosis have spinal cord involvement; however, among all patients with sarcoidosis, the incidence of isolated spinal cord is only 0.43% [3,17].…”