J Korean Neurosurg Soc.  2014 Nov;56(5):436-440. 10.3340/jkns.2014.56.5.436.

Intramedullary Sarcoidosis Presenting with Delayed Spinal Cord Swelling after Cervical Laminoplasty for Compressive Cervical Myelopathy

• Kwon DH
• Lee SH
• Kim ES
• Eoh W

• KMID: 2018105
• DOI: http://doi.org/10.3340/jkns.2014.56.5.436

Abstract

Sarcoidosis is a systemic disease of unknown etiology that may affect any organ in the body. The nervous system is involved in 5-16% of cases of sarcoidosis. Here, we report a case of intramedullary sarcoidosis presenting with delayed spinal cord swelling after laminoplasty for the treatment of compressive cervical myelopathy. A 56-year-old woman was admitted to our hospital complaining of upper extremity pain and gait disturbance. The patient had undergone laminoplasty for compressive cervical myelopathy 3 months previously. Follow-up magnetic resonance imaging revealed a large solitary intramedullary lesion with associated extensive cord swelling, signal changes, and heterogeneous enhancement of spinal cord from C2 to C7. Spinal cord biopsy revealed non-necrotizing granulomas with signs of chronic inflammation. The final diagnosis of sarcoidosis was based upon laboratory data, imaging findings, histological findings, and the exclusion of other diagnoses. Awareness of such presentations and a high degree of suspicion of sarcoidosis may help arrive at the correct diagnosis.

Keyword

Intramedullary; Laminoplasty; Sarcoidosis; Spinal cord

MeSH Terms

Biopsy
Diagnosis
Female
Follow-Up Studies
Gait
Granuloma
Humans
Inflammation
Magnetic Resonance Imaging
Middle Aged
Nervous System
Sarcoidosis*
Spinal Cord Diseases*
Spinal Cord*
Upper Extremity

Figure

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  Fig. 1 A : A preoperative T2-weighted sagittal magnetic resonance imaging (MRI) scan shows marked spinal cord compression from C5 to C8 and an enhanced lesion at the C5-7 vertebral body. B : A postoperative T2-weighted sagittal MRI scan shows disappearance of the spinal cord compression from C5 to C8.

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  Fig. 2 T2-weighted (A) and T1-weighted (B) follow-up magnetic resonance imaging (MRI) scans at readmission show edematous expansion of the spinal cord and enhanced nodules involving the C4 to C6 levels of the spinal cord. A gadolinium-enhanced T1-weighted MRI scan shows enhancement at multiple vertebra and heterogeneous intramedullary enhancement extending from C3 to C6 (C).

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  Fig. 3 Microscopic examination revealed several granulomas and central aggregation of epithelioid histiocytes with infiltration of lymphocytes at the periphery, consistent with non-caseating granuloma observed in sarcoidosis (hematoxylin and eosin staining, 400×).

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  Fig. 4 T2-weighted (A) and T1-weighted (B) follow-up magnetic resonance imaging scans acquired after steroid therapy show that the nodule at the spinal cord is no longer enhanced and expansion of the spinal cord. A gadolinium-enhanced T1-weighted image shows that the enhanced nodule at the site of the spinal lesion is reduced in size (C).

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