Intramedullary spinal neurosarcoidosis

Abstract

Neurosarcoidosis is a rare diagnosis, and it is also unusual for a patient with sarcoidosis to present solely with neurologic disease. However, CNS involvement can be the first manifestation of disease in 50% of patients. Thus, it is an important diagnostic consideration in patients presenting with ambiguous nervous-system lesions, particularly in the population most often affected by sarcoidosis: young African-Americans. We report a case of a 32-year-old African-American male with spinal sarcoidosis presenting as bilateral upper-extremity and upper-trunk parasthesias secondary to an intramedullary spinal lesion.

Figure 1

32-year-old male with intramedullary spinal neurosarcoidosis. Postcontrast T1-weighted images revealed a 1cm enhancing lesion (arrow) at C5-C6 with associated cord edema and expansion.

Figure 2

32-year-old male with intramedullary spinal neurosarcoidosis. The lesion (arrow) had low signal intensity centrally with peripheral hyperintensity on T2-weighted images (A). A hyperintense syrinx, extending 1.8cm, lies proximal to the lesion (arrow) (B).

Figure 3

32-year-old male with intramedullary spinal neurosarcoidosis. T2-weighted images demonstrated increasing cord expansion and edema (A). Imaging six weeks later demonstrated markedly increased cord edema and cord expansion extending from C2 to T2 and associated with a syrinx in the upper thoracic spinal cord (B).

Figure 4

32-year-old male with intramedullary spinal neurosarcoidosis. Postoperative MRI scans with laminectomies from C4-C7. The postcontrast T1-weighted image showed decreased enhancement of the lesion (arrow) at C5-C6 compared to pre-operative scans (A). The T2-weighted image showed marked decrease in hyperintensity (arrow) compared to pre-operative scans. There was only mild cord enlargement at the level of the lesion, and the edema extended only from C4-C7, compared to C2-T2 before surgery (B).