Spinal neurosarcoidosis.

ABSTRACT

PURPOSE: Neurosarcoidosis is a multisystemic disorder and is rare in Taiwan. Diagnosis of neurosarcoidosis depends on the clinical features, neuroimage studies and the pathological findings of non-caseous granuloma in various tissues. CASE REPORT A 62-year-old woman had diabetic mellitus and an old lacunar stroke in 1996. In 2003, she received steroid therapy for one year for the mediastinal mass lesion with a good response. In June 2006, she suffered from band-like numbness and muscle weakness descending from the abdomen to bilateral lower extremities and urinary difficulty. Spinal magnetic resonance imaging showed an intramedullary lesion in C6~C7 region. The chest computed tomography (CT) scan revealed multiple small and enlarged nodes over the mediastinal regions compared with the previous chest CT in 2005. The pathological changes of the mediastinal mass demonstrated non-caseous granulomatous changes. Therefore, probable cervical neurosarcoidosis was impressed. After an intravenous dexamethasone followed by oral steroid treatment, her symptoms and signs had gradually improved. A follow-up spinal magnetic resonance imaging showed an improvement of the cervical cord lesion. CONCLUSION: Spinal neurosarcoidosis can mimic a spinal tumor, an inflammatory lesion, or even a demyelinating lesion in both clinical and neuroimaging studies. A high index of suspicion of sarcoidosis is required for an early diagnosis, and steroid therapy is usually associated with a favorable outcome.