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Case Reports
. 2022 Jul 26;13(1):191-197.
doi: 10.1515/tnsci-2022-0231. eCollection 2022 Jan 1.

Neurosarcoidosis presenting as longitudinally extensive myelitis: Diagnostic assessment, differential diagnosis, and therapeutic approach

Alessandra Cicia  1   2 , Viviana Nociti  1   2 , Assunta Bianco  1   2 , Chiara De Fino  1 , Vincenzo Carlomagno  1   2 , Massimiliano Mirabella  1   2 , Matteo Lucchini  1   2
Affiliations
Case Reports

Neurosarcoidosis presenting as longitudinally extensive myelitis: Diagnostic assessment, differential diagnosis, and therapeutic approach

Alessandra Cicia et al. Transl Neurosci. .

Abstract

Neurosarcoidosis is an uncommon and multiform clinical entity. Its presentation as an isolated longitudinal extensive transverse myelitis (LETM) is rare and challenging to identify. We report a case of LETM in a 60-year-old patient with no significant systemic symptoms nor relevant medical history. The peculiar spinal magnetic resonance imaging finding characterized by a posterior and central canal subpial contrast enhancement, the so-called "trident sign," together with chest computed tomography scan and lymph node biopsy led to the diagnosis of sarcoidosis. We also discuss the main differential diagnoses of LETM and therapeutic options for sarcoidosis-related myelitis.

Keywords: longitudinally extensive transverse myelitis; neurosarcoidosis; sarcoidosis; treatment; trident sign.

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Conflict of interest statement

Conflict of interest: Authors state no conflict of interest.

Figures

Figure 1
Figure 1
(a–d) Spinal MRI at clinical onset. (b) Sagittal T2-weighted image showing the hyperintense lesion extending from C5 to D2 (asterisks); (c) Sagittal T1 post-contrast sequence showing posterior subpial contrast enhancement (asterisks). Axial T1 post-contrast (a) and t2-weighted (d) sequences at symptoms’ onset showing the “trident sign” (asterisk). (e and f) spinal MRI 6 months after treatment. Sagittal T2-weighted (e) and T1 post-contrast (f) sequences showing an almost complete disappearance of the spinal lesion.
Figure 2
Figure 2
Axial chest CT scan showing bilateral hilar adenopathy (asterisks).
See this image and copyright information in PMC

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