1. 1) 60-year-old woman with biopsy-proven pulmonary sarcoidosis presented with progressive numbness in all limbs. MRI suggested cord compression due to degenerative disc disease C5-7 with cord edema and T2 hyperintensity C4-T1. Neurosurgery prescribed hard collar with plan for decompression. CSF had elevated protein (66) with 6 nucleated cells. Diagnosis of neurosarcoidosis was made with complete response to IV steroids.
2. 2) 55-year-old man presented with neck pain and progressive tingling in hands and legs. MRI showed cord compression due to disc herniations C5-7 with cord edema and T2 hyperintensity C2-7, leading to urgent posterior laminectomy and fusion. Post-operative MRI showed worsened cord edema, patchy contrast enhancement, and extension of T2 hyperintensity to T4 level. CSF had elevated protein (60) and 30 nucleated cells. CT chest showed mediastinal lymphadenopathy. Lymph node biopsy revealed non-necrotizing granulomas, consistent with sarcoidosis.
3. 3) 58-year-old man presented with acute on chronic paresthesias and triparesis. MRI showed cord compression due to disc herniation C6-7 with cord edema and T2 hyperintensity C2-T1. He underwent urgent posterior and later anterior laminectomies and fusions with continued worsening of weakness. CSF had elevated protein (121) and 10 nucleated cells. CT chest showed mediastinal and hilar lymphadenopathy. Bronchoscopic fine needle aspiration cytology showed non-necrotizing granulomas, consistent with sarcoidosis.

Sarcoid myelitis may present with the appearance of compression myelopathy. In our patients, distinguishing features included longitudinally extensive signal change beyond the levels of disc disease and cord edema. Recognizing these signs is critical to avoid unnecessary invasive procedures.