Spinal Cord Sarcoidosis Occurring at Sites of Spondylotic Stenosis, Mimicking Spondylotic Myelopathy: A Case Series and Review of the Literature

• Published in: American journal of neuroradiology : AJNR Vol. 44; no. 1; pp. 105 - 110
• Main Authors: Kurtz, R M, Babatunde, V D, Schmitt, J E, Berger, J R, Mohan, S
• Format: Journal Article
• Language: English
• Published: United States American Society of Neuroradiology 01.01.2023
• Subjects: Cervical Vertebrae - surgery; Constriction, Pathologic - pathology; Fellows' Journal Club; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Sarcoidosis - diagnostic imaging; Sarcoidosis - pathology; Spinal Cord - diagnostic imaging; Spinal Cord - pathology; Spinal Cord Compression; Spinal Cord Diseases - diagnostic imaging; Spinal Cord Diseases - pathology; Spinal Stenosis - diagnostic imaging; Spinal Stenosis - pathology; Spine; Spondylosis - diagnostic imaging
• ISSN: 0195-6108; 1936-959X
• DOI: 10.3174/ajnr.a7724

Sarcoidosis is a multisystem granulomatous disease, with intramedullary spinal cord involvement seen in <1% of cases. This case series illustrates the clinical presentations and imaging findings of 5 patients with intramedullary spinal neurosarcoidosis occurring at sites of spondylotic spinal canal stenosis, which can be indistinguishable from spondylotic myelopathy with cord enhancement. Both entities are most common in middle-aged men and present with weeks to months of motor and sensory symptoms. On imaging, both can have focal spinal cord enhancement and longitudinally extensive signal abnormality centered at or just below the level of spinal canal stenosis. On the basis of our experience, we suggest that in patients with cord enhancement centered at or just below a site of spinal canal stenosis, consideration should be given to chest imaging and lymph node biopsy when applicable, to assess for the possibility of underlying sarcoidosis before surgical decompression.