Neurosarcoidosis Masquerading as Spinal Stenosis.

Diagnostics (Basel)

Rheumatology Unit, Carmel Medical Center, Haifa 3436212, Israel.

Published: October 2024

AI Article Synopsis

  • A 65-year-old woman experienced progressive pain, weakness in limbs, and urinary incontinence, leading to a hospitalization for evaluation of a suspected demyelinating disease.
  • MRI showed spinal cord compression due to complex disc issues and localized enhancement, prompting further tests to rule out infections and malignancies.
  • The patient was ultimately diagnosed with both neurosarcoidosis and spondylotic myelopathy, and after treatment, she showed significant clinical and radiographic improvement.

Article Abstract

A 65-year-old woman was admitted to the neurology department with a suspected demyelinating disease due to complaints of progressive pain and weakness in both upper and lower limbs, as well as urinary incontinence. MRI of the spine revealed complex disc osteophyte with compression of the spinal cord in the cervical and lumbar spine at several vertebral levels, and localized enhancement in the cervical spine at the site of maximal spinal canal stenosis. During her hospitalization, the patient underwent extensive evaluation to rule out any systematic inflammatory diseases, infections, and malignancy. Chest CT revealed bilateral mediastinal lymphadenopathy. Transbronchial mediastinal lymph node biopsy showed numerous non-necrotizing granulomas without evidence of malignancy. After a thorough and careful exclusion of a demyelinating, infectious, and paraneoplastic myelopathies, and based on clinical, radiographic, and pathological findings, the patient was diagnosed with both neurosarcoidosis and spondylotic myelopathy. She was then treated for neurosarcoidosis, including glucocorticosteroids, azathioprine, and a biosimilar of the anti-TNF alpha agent infliximab, resulting in both clinical and radiographic improvement. Intramedullary spinal neurosarcoidosis is very rare and may present with clinical features of spondylotic myelopathy, with typical imaging findings occurring only in areas of spinal canal stenosis.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11506506PMC
http://dx.doi.org/10.3390/diagnostics14202296DOI Listing

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