SUMMARY A 26-year-old male with a history of pulmonary sarcoidosis showed clinical, myelographic and intra-operative evidence of a C5-C6 spinal cord tumour, which was diagnosed by biopsy as a pure intramedullary granuloma. Among the 29 published cases of histologically proven cord sarcoidosis, only five presented with pure parenchymatous infiltration without meningeal involvement. Corticosteroids are the most useful therapy, and surgery is indicated only for minimal biopsy when the parenchyma is invaded.Spinal cord involvement is a very rare but well documented manifestation of sarcoidosis. Including the first pathological description of the condition by Longcope in 1941,' only 29 cases of histologically proven spinal cord sarcoidosis diagnosed antemortem or postmortem have been published (reviews in refs 2, and 3-14). Anatomically, the lesions have been variously distributed within the spinal cord but almost invariably involve the meninges. We report a case of pure intramedullary granuloma without meningeal involvement, in which the clinical, radiological and intraoperative findings were suggestive of a cervical cord tumour.
Case reportA 27-year-old Algerian male was referred in October 1982 with a 2 months history of increasing bilateral arm weakness, difficulty in walking, and bladder urgency. He also complained of upper dorsal backache radiating to the anterior chest. His past medical history was remarkable only for pulmonary sarcoidosis. This condition had been diagnosed by bronchial biopsy five years previously, and treated with corticosteroid, levamisole and azathioprine until July 1981. On examination, he was able to walk for only a few meters without aid. He had a spastic tetraparesis, which was more prominent on his right side. Severe amyotrophy was present in both hands, right greater than left, and was associated with continuous fasciculations which caused minimal finger displacements. All tendon reflexes were brisk, save for triceps reflexes which were inverted; bilateral extensor plantar responses were elicited. Pain and thermal sensation was moderately decreased below T4, and a hypoaesthetic band in the right C8-T1 territories was noted. Electromyography showed denervation bilaterally in the C7, C8, and Ti territories. Motor and sensory conduction velocities were normal in both arms. Somatosensory evoked potentials showed reduced amplitude and normal latency of the cervical Nll and NB1 components following stimulation of the right median nerve. Visual evoked potentials were normal. Erythrocyte sedimentation rate, plasma calcium level, protein immuno-electrophoresis, plasma and urinary osmolalities were all normal. CSF was clear, with elevation of both protein content (1-66 g/l) and globulin fraction (17%). Cell count (2 WBC.mm3) and glucose level (2-8 mmol/l) were normal. Bacterial and fungal cultures were negative. Angiotensin converting enzyme was 90 nmol/mn/ml in serum (normal value = 35 + 10 nmol/mn/ml) and was not detected in CSF. Radiographs of the cervical spine were normal. Myelography dem...