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Isolated neurosarcoidosis - MR findings and pathologic correlation
M K Bode1, T Tikkakoski, S Tuisku
1Department of Radiology, Keski-Pohjanmaa Central Hospital, Kokkola, Finland.
Abstract:
Neurosarcoidosis is a diagnostic challenge, especially if systemic symptoms are absent. We present a 49-year-old woman with isolated neurosarcoidosis. The main symptom was loss of vision in the left eye. Brain MR imaging showed 6 high-signal white matter lesions frontotemporally on proton density and T2-weighted turbo spin-echo images. Coronal fat-saturated turbo FLAIR images of the orbits showed a swollen left optic nerve with increased signal intensity, which finding has not been previously published in sarcoid optic neuropathy. A control MR examination showed meningeal enhancement of the left optic nerve and leptomeningeal enhancing lesions around the brain stem. Spinal MR revealed leptomeningeal enhancement throughout the spinal cord and asymptomatic enhancing cauda equina lesions, mimicking subarachnoid tumour seeding, and an enhancing nerve root mass at Th12/L1. Biopsy of the latter lesion revealed non-caseating granulomas consistent with sarcoidosis.
Insights
Isolated neurosarcoidosis, a rare neurological condition, can present without systemic symptoms. This case highlights optic nerve and spinal cord involvement, emphasizing the need for thorough investigation in suspected neurosarcoidosis.
Area of Science:
- Neurology
- Immunology
- Radiology
Background:
- Neurosarcoidosis presents diagnostic challenges, particularly when systemic symptoms are absent.
- Isolated neurosarcoidosis requires careful consideration in differential diagnoses.
Observation:
- A 49-year-old woman presented with isolated neurosarcoidosis, primarily manifesting as left eye vision loss.
- Brain MRI revealed white matter lesions and optic nerve abnormalities, including increased signal intensity in the left optic nerve, a previously undocumented finding in sarcoid optic neuropathy.
- Spinal MRI demonstrated extensive leptomeningeal enhancement and nerve root lesions mimicking tumor seeding.
Findings:
- Biopsy of a nerve root mass confirmed non-caseating granulomas, consistent with sarcoidosis.
- The findings underscore the diverse and sometimes subtle manifestations of neurosarcoidosis.
Implications:
- This case expands the understanding of neurosarcoidosis imaging findings, particularly optic nerve and spinal leptomeningeal involvement.
- Highlights the importance of comprehensive neuroimaging in diagnosing isolated neurosarcoidosis.
- Suggests considering neurosarcoidosis in the differential diagnosis of unexplained optic neuropathy and spinal leptomeningeal disease.