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Neurosarcoidosis Masquerading as Spinal Stenosis.
Ameen Batheesh1, Nina Borissovsky2, Devy Zisman1,3
1Rheumatology Unit, Carmel Medical Center, Haifa 3436212, Israel.
Diagnostics (Basel, Switzerland)
|October 25, 2024
Summary
This case study highlights rare intramedullary spinal neurosarcoidosis mimicking spondylotic myelopathy. Prompt diagnosis and treatment with immunosuppressants led to significant clinical and radiographic improvement.
Area of Science:
- Neurology
- Immunology
- Radiology
Background:
- Intramedullary spinal neurosarcoidosis is a rare condition.
- It can present with symptoms mimicking other spinal cord diseases like spondylotic myelopathy.
- Early diagnosis and treatment are crucial for patient outcomes.
Purpose of the Study:
- To report a rare case of intramedullary spinal neurosarcoidosis.
- To discuss the diagnostic challenges and treatment strategies.
- To emphasize the importance of considering neurosarcoidosis in patients with myelopathy symptoms.
Main Methods:
- Clinical presentation and neurological examination.
- Spinal MRI with contrast.
- Chest CT scan.
- Mediastinal lymph node biopsy.
- Exclusion of other myelopathies (demyelinating, infectious, paraneoplastic).
Main Results:
- Patient presented with progressive pain, weakness, and urinary incontinence.
- Spinal MRI showed cervical and lumbar spinal cord compression with enhancement.
- Mediastinal lymph node biopsy revealed non-necrotizing granulomas.
- Diagnosis of neurosarcoidosis and spondylotic myelopathy was established.
- Treatment with glucocorticosteroids, azathioprine, and infliximab resulted in improvement.
Conclusions:
- Intramedullary spinal neurosarcoidosis can mimic spondylotic myelopathy clinically and radiographically.
- Diagnostic workup should include exclusion of other myelopathies and systemic evaluation for granulomatous disease.
- Multimodal treatment approach is effective for managing spinal neurosarcoidosis.
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