Sarcoidosis of the spinal cord and medulla oblongata. A pathological and neuroradiological case report

A case of 68-year-old woman with symptoms of slowly progressive diffuse myelopathy, is presented, which could only temporally be reversed by immunosuppression. Contrast enhanced magnetic resonance (MR) scan demonstrated multifocal patchy enhancing lesions from cervical to mild thoracic segment and a circumscribed lesion of the whole medulla oblongata. Postmorten examination disclosed a histological confirmed, multifocal sarcoidosis of the spinal cord and medulla oblongata, with few sarcoid granulomas in one hilar lymph node and skeletal muscle of the upper extremities. Only nine similar cases of intramedullary sarcoidosis confirmed by autopsy with symptoms solely attributable to the spinal cord have been reported. A review of the pathological manifestations, diagnostic and treatment of intramedullary sarcoidosis is given.