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[Spinal cord involvement revealing systemic sarcoidosis].
P Cacoub1, A Sbaï, P Hausfater
1Service de Médecine Interne, La Pitié-Salpêtrière, Paris. patrice.cacoub@psl.ap-hop-paris.fr
Revue Neurologique
|October 18, 2000
Summary
Spinal neurosarcoidosis, a rare condition, can be the first sign of sarcoidosis. Early diagnosis and corticosteroid treatment led to significant improvement and no relapse in a patient with spinal cord involvement.
Area of Science:
- Neurology
- Immunology
- Radiology
Background:
- Spinal neurosarcoidosis is a rare manifestation of sarcoidosis, occurring in 0.43% of cases and sometimes presenting as the initial symptom.
- Neurosarcoidosis typically involves extraneurologic abnormalities, with spinal cord involvement seen in only 6-10% of patients.
Observation:
- A 43-year-old man presented with progressive neck pain, leg weakness, and gait disturbance.
- MRI revealed diffuse spinal cord enlargement and enhancement from C2 to T7, while cranial MRI was normal.
- Chest imaging showed hilar mediastinal lymphadenopathy; bronchial biopsy confirmed non-caseating granulomas.
Findings:
- Elevated serum angiotensin-converting enzyme levels supported the diagnosis.
- Corticosteroid treatment resulted in marked improvement of neurological symptoms.
- Follow-up MRI showed resolution of spinal cord abnormalities, with no relapse after two years.
Implications:
- This case highlights spinal neurosarcoidosis as a potential initial presentation of sarcoidosis.
- Prompt diagnosis and treatment are crucial for favorable outcomes in spinal neurosarcoidosis.
- While extraneurologic biopsies are common for diagnosis, spinal cord biopsy may be considered selectively.