[Spinal cord sarcoidosis--diagnostic value of Gd-enhanced MRI]

A 50-year-old man was admitted because of slowly progressive myelopathy for the last ten months without a correct diagnosis. The CSF showed mild pleocytosis (predominantly mononuclear cells) together with elevated protein content. MRI findings after administration of Gd-DTPA were characteristic: diffuse swelling of the lower cervical and upper thoracic cord, multiple patchy enhanced areas in the cord parenchyma adjacent to meninges, and linear meningeal enhancement. Based on these observations, a scalene node biopsy was performed, yielding a pathological diagnosis of sarcoidosis. The clinical neurological signs as well as the abnormal MRI findings of myelopathy were considerably improved after prednisolone therapy. An early diagnosis of spinal cord involvement in sarcoidosis should be established, because it is treatable in the earlier stage. Mild inflammatory evidence in CSF and Gd-enhanced MRI findings may be the cardinal clues to the diagnosis.