Isolated cervical intramedullary sarcoidosis--a histological surprise

Mathieson, Calan; Mowle, David; Ironside, James W.; O'Riordan, R

doi:10.1080/02688690400022920

Cited by 18 publications

(14 citation statements)

References 6 publications

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“…38 -41 Mathieson et al demonstrated that among 31 cases of histologically proven intramedullary sarcoidosis, postoperative deterioration in neurologic function occurred in 50% cases. 42 Thus, several reports suggest that the first surgery should be limited to decompression of the spinal cord and biopsy without complete extirpation in cases of suspected spinal cord sarcoidosis. 10,[43][44][45][46] However, there has been no report describing the effects of spinal cord decompression on lesions in sarcoidosis.…”

Section: Discussionmentioning

confidence: 99%

Is Decompressive Surgery Effective for Spinal Cord Sarcoidosis Accompanied With Compressive Cervical Myelopathy?

Sakai¹,

Matsuyama²,

Imagama³

et al. 2010

Spine

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Section: Discussionmentioning

confidence: 99%

Is Decompressive Surgery Effective for Spinal Cord Sarcoidosis Accompanied With Compressive Cervical Myelopathy?

Sakai¹,

Matsuyama²,

Imagama³

et al. 2010

Spine

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“…Treatment is implemented to reduce symptoms and can possibly lead to remission. A literature review of histologically proven intramedullary sarcoidosis showed that 50% of patients who underwent a more extensive resection suffered a postoperative deterioration in neurological function [16]. In contrast, the deterioration was only seen in 28% of limited biopsy patients.…”

Section: Discussionmentioning

confidence: 99%

Is extensive cervical laminoplasty an effective treatment for spinal cord sarcoidosis combined with cervical spondylosis?

Doita

Miyata

et al. 2009

Eur Spine J

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Patients with neurosarcoidosis are usually initially treated with steroid administration even when they have concomitant cord compression on magnetic resonance imaging (MRI). Operative intervention may be indicated in patients with spinal cord sarcoidosis requiring either tissue biopsy for diagnosis or associated with progressive neurologic symptoms. However, there have been no previous reports describing clinical outcomes of laminoplasty for spinal cord sarcoidosis. The objectives of this study are to investigate whether extensive cervical laminoplasty is an effective treatment for spinal cord sarcoidosis combined with spondylotic changes and/or cervical spinal canal stenosis. Open-door laminoplasty was performed in three patients with spinal cord sarcoidosis. All patients received intensive corticosteroid therapy after the operation MRI imaging was performed in all patients before and after the operation. Operative outcomes were not satisfactory and the clinical courses of the patients fluctuated after corticosteroid therapy. Daily life activities were not significantly improved after treatments in any of the three patients, and in the long-term follow-up period the clinical course of one patient was one of inexorable deterioration to a state of quadriplegia. The possibility of spinal cord sarcoidosis should be included in the differential diagnosis, when a distinct high signal intensity area is observed within the spinal cord on T2-weighted MR images in patients with spondylotic changes. Laminoplasty is not an effective intervention for the treatment of spinal cord sarcoidosis even when patients have spondylotic changes and/or a constitutionally narrowing cervical spinal canal. Patients with neurosarcoidosis should be treated first with steroid administration even when they have concomitant cord compression on MRI.

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“…In a review of the literature of 48 cases of spinal cord sarcoidosis, intramedullary involvement was seen in 35% of cases, extramedullary involvement in 35% of cases and both were involved in 23% of patients. 3 Half of the cases with intramedullary involvement had evidence of systemic sarcoidosis. The cervical cord was involved in 70% of the cases.…”

Section: Discussionmentioning

confidence: 99%

“…The cervical cord was involved in 70% of the cases. 3 Spinal cord sarcoidosis begins with linear leptomeningeal involvement along the surface of the spinal cord, followed by parenchymal involvement secondary to spread of the inflammatory process along the VirchowRobin perivascular spaces. 4 In the long term there is abatement of the inflammatory process with residual neuronal damage and spinal cord atrophy.…”

Section: Discussionmentioning

confidence: 99%

Intramedullary cervical spinal cord sarcoidosis

Bhagavati

Choi

2008

Spinal Cord

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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.

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Isolated cervical intramedullary sarcoidosis--a histological surprise

Cited by 18 publications

References 6 publications

Is Decompressive Surgery Effective for Spinal Cord Sarcoidosis Accompanied With Compressive Cervical Myelopathy?

Is Decompressive Surgery Effective for Spinal Cord Sarcoidosis Accompanied With Compressive Cervical Myelopathy?

Is extensive cervical laminoplasty an effective treatment for spinal cord sarcoidosis combined with cervical spondylosis?

Intramedullary cervical spinal cord sarcoidosis

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