Spinal cord sarcoidosis

Abstract

Three patients with spinal cord involvement by sarcoid are described and the literature is reviewed. Fifteen patients with histologically verified sarcoidosis involving the spinal cord presented with progressive myelopathy due to tumor. Myelography variously showed an extramedullary intradural mass; an intramedullary mass; a thinned, atrophic cord; or normal configuration.Although laminectomy and biopsy arc often required to establish the diagnosis, treatment is medical, using corticosteroid drugs. Treatment seldom leads to complete recovery, but neurological deficits may stabilize or improve.Day Laminecrorny disclosed a 3 x 2 cm mass adherent to and continuous with the spinal cord. T h e r e was no plane of cleavage, and subtotal removal using the operating microscope was performed. Biopsy showed noncaseating granulomatous tissue with numerous giant cells, compatible with sarcoid (Fig 2). Postoperatively the patient was placed o n a regimen of 80 mg of prednisone per day, and h e recovered uneventfully. T h e r e was no immediate change in strength, but sensory abnormalities related to rhizotomy of T8 and T9 resultcd in some mild dysesthesias. O v e r the ensuing 15 months he expericnced an initial milJ subjective increase in sensory deficit and spasticity that was not confirmed by examination. He is able t o walk

Isolated Intramedullary Thoracic Spinal Sarcoidosis: A Case Report and Review of the Literature

“…Beyond medical therapy, there are few treatment options specific to spinal sarcoidosis. Surgery allows lesion biopsy for diagnosis, but aggressive resection beyond that can lead to disease progression and patient deterioration [36]. All but one case in the literature review had surgery for lesion biopsy.…”

Isolated Intramedullary Thoracic Spinal Sarcoidosis: A Case Report and Review of the Literature

“…Beyond medical therapy, there are few treatment options specific to spinal sarcoidosis. Surgery allows lesion biopsy for diagnosis, but aggressive resection beyond that can lead to disease progression and patient deterioration [36]. All but one case in the literature review had surgery for lesion biopsy.…”

Isolated spinal neurosarcoidosis: An enigmatic intramedullary spinal cord pathology-case report and review of the literature

“…Spinal sarcoidosis can present with varied symptoms, including weakness; paresthesias; myelopathy; demyelinating syndrome; facial nerve paralysis; bowel, bladder, or sexual disturbances; and back pain or even radicular pain which are no different from other spinal cord pathologies which are much more common than spinal sarcoidosis. [721353637]…”

“…Since the proposed mechanism by which sarcoidosis becomes intramedullary is via extension through perivascular spaces, the leptomeningeal biopsies may be of value as the arachnoid is often infiltrated with lymphocytes and the typical granulomas increasing the diagnostic yield of frozen section. [37]…”

Isolated intramedullary neurosarcoidosis of the thoracic spine: case report and review of the literature

“…Spinal cord involvement is more prevalent in the cervical spine (56%) than in the thoracic (37%) and lumbosacral (7%) spine [16,17]. Spinal sarcoidosis can present with varied symptoms, including weakness, paresthesias, myelopathy, demyelinating syndrome [18], facial nerve paralysis [28], bowel, bladder, or sexual disturbances, back pain [10,26], or even radicular pain [30]. The characteristic demographic of spinal sarcoidosis is a male patient, 20-40 years of age, of Northern European or African descent.…”

“…In cases in which leptomeningeal biopsies are obtained, the arachnoid is often infiltrated with lymphocytes and the typical granulomas. The proposed mechanism by which sarcoidosis becomes intramedullary is via extension through perivascular spaces [10].…”

Isolated Intramedullary Thoracic Spinal Sarcoidosis: A Case Report and Review of the Literature

“…Beyond medical therapy, there are few treatment options specific to spinal sarcoidosis. Surgery allows lesion biopsy for diagnosis, but aggressive resection beyond that can lead to disease progression and patient deterioration [36]. All but one case in the literature review had surgery for lesion biopsy.…”

Isolated spinal neurosarcoidosis: An enigmatic intramedullary spinal cord pathology-case report and review of the literature

“…Spinal sarcoidosis can present with varied symptoms, including weakness; paresthesias; myelopathy; demyelinating syndrome; facial nerve paralysis; bowel, bladder, or sexual disturbances; and back pain or even radicular pain which are no different from other spinal cord pathologies which are much more common than spinal sarcoidosis. [721353637]…”

“…Since the proposed mechanism by which sarcoidosis becomes intramedullary is via extension through perivascular spaces, the leptomeningeal biopsies may be of value as the arachnoid is often infiltrated with lymphocytes and the typical granulomas increasing the diagnostic yield of frozen section. [37]…”

Isolated intramedullary neurosarcoidosis of the thoracic spine: case report and review of the literature

“…Spinal cord involvement is more prevalent in the cervical spine (56%) than in the thoracic (37%) and lumbosacral (7%) spine [16,17]. Spinal sarcoidosis can present with varied symptoms, including weakness, paresthesias, myelopathy, demyelinating syndrome [18], facial nerve paralysis [28], bowel, bladder, or sexual disturbances, back pain [10,26], or even radicular pain [30]. The characteristic demographic of spinal sarcoidosis is a male patient, 20-40 years of age, of Northern European or African descent.…”

“…In cases in which leptomeningeal biopsies are obtained, the arachnoid is often infiltrated with lymphocytes and the typical granulomas. The proposed mechanism by which sarcoidosis becomes intramedullary is via extension through perivascular spaces [10].…”

Isolated Intramedullary Thoracic Spinal Sarcoidosis: A Case Report and Review of the Literature

“…Beyond medical therapy, there are few treatment options specific to spinal sarcoidosis. Surgery allows lesion biopsy for diagnosis, but aggressive resection beyond that can lead to disease progression and patient deterioration [36]. All but one case in the literature review had surgery for lesion biopsy.…”

Isolated spinal neurosarcoidosis: An enigmatic intramedullary spinal cord pathology-case report and review of the literature

“…Spinal sarcoidosis can present with varied symptoms, including weakness; paresthesias; myelopathy; demyelinating syndrome; facial nerve paralysis; bowel, bladder, or sexual disturbances; and back pain or even radicular pain which are no different from other spinal cord pathologies which are much more common than spinal sarcoidosis. [721353637]…”

“…Since the proposed mechanism by which sarcoidosis becomes intramedullary is via extension through perivascular spaces, the leptomeningeal biopsies may be of value as the arachnoid is often infiltrated with lymphocytes and the typical granulomas increasing the diagnostic yield of frozen section. [37]…”

Isolated intramedullary neurosarcoidosis of the thoracic spine: case report and review of the literature

“…Spinal cord involvement is more prevalent in the cervical spine (56%) than in the thoracic (37%) and lumbosacral (7%) spine [16,17]. Spinal sarcoidosis can present with varied symptoms, including weakness, paresthesias, myelopathy, demyelinating syndrome [18], facial nerve paralysis [28], bowel, bladder, or sexual disturbances, back pain [10,26], or even radicular pain [30]. The characteristic demographic of spinal sarcoidosis is a male patient, 20-40 years of age, of Northern European or African descent.…”

“…In cases in which leptomeningeal biopsies are obtained, the arachnoid is often infiltrated with lymphocytes and the typical granulomas. The proposed mechanism by which sarcoidosis becomes intramedullary is via extension through perivascular spaces [10].…”