Multifocal Epidural Neurosarcoidosis Causing Spinal Cord Compression: A Case Report

Abstract

We describe a rare case of multifocal extramedullary epidural neurosarcoidosis that presented with myelopathy without motor deficits and perform a literature review for previous cases of epidural neurosarcoidosis. A 46-year-old woman presented with lower back pain, urinary incontinence, gait disturbance, and sensory loss without motor deficits. Spine magnetic resonance imaging (MRI) showed multiple epidural lesions, the largest causing spinal cord compression at the T5 level. A computed tomography (CT)-guided biopsy of the dominant lesion showed noncaseating granulomas consistent with neurosarcoidosis. She was treated with a course of dexamethasone and discharged home after a 10-day hospital course. She was discharged home on oral prednisone taper over a four-month period. At her latest follow-up, she is neurologically intact and gainfully employed. This case demonstrates that certain cases of epidural neurosarcoidosis causing spinal cord compression may be treated with medical therapy alone in the absence of severe neurological deficits.

Recurrence of Epidural Spinal Sarcoidosis

“…At 1 week after discharge, her gait had improved markedly, and at 18 months after initial admission, she was ambulating without difficulty, neurologically intact, and employed. 23 Similarly, Nardon et al 25 also reported a case of an 80-year-old woman with cervical neurosarcoidosis who was also managed with 2 months of steroids with improved neurologic function and MRI demonstrating a resolution of epidural mass.…”

“… 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 ).…”

“… 20 - 22 , 24 25 26 27 After surgical decompression, each patient underwent medical management with steroid taper 20 - 22 , 24 25 26 27 and two patients had additional methotrexate therapy. 21 , 24 Longo et al 23 reported a patient with multiple epidural lesions at T4-T6, T8, and L2-L3 who only received medical management, initially with 10 mg bolus of dexamethasone followed by 4 mg dexamethasone every 6 hours. She was then discharged with oral prednisone taper over a 4-month period.…”

“… 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. 24 To the best of our knowledge, the reporting of recurrent intraspinal epidural sarcoidosis in the spine has only been reported once in a pediatric patient.…”

Cervical epidural neurosarcoidosis: A case report and literature review

“…Medical management usually includes steroids (e.g., in some cases, require a prolonged course of steroid utilization) along with immunosuppressive medications(e.g., methotrexate). [3,4]…”