Abstract Details

Title Decompressing the Truth: Neurosarcoidosis Manifesting as Compressive Myelopathy?

Topic Autoimmune Neurology

Presentation(s) P8 - Poster Session 8 (8:00 AM-9:00 AM)

Poster/Presentation
Number 8-019

Objective This case examines the intricate relationship between neurosarcoidosis and compressive myelopathy amid multilevel thoracic disc herniation, focusing on diagnostic challenges and treatment implications.

Background Neurosarcoidosis is a rare manifestation of sarcoidosis, characterized by granulomatous lesions affecting the nervous system. Diagnosing it is challenging due to nonspecific symptoms like cranial nerve palsy, cognitive impairment, and motor weakness. Early recognition is crucial to prevent severe morbidity. This case discusses a young woman with a recent diagnosis of pulmonary sarcoidosis presenting with a three-week history of progressive bilateral lower extremity numbness and weakness.

Design/Methods N/A

Results

Examination revealed marked lower extremity weakness, sensory impairment, and urinary retention. Thoracic spine MRI with contrast revealed T2 hyperintense signal from T5-T10 with expansile cord edema associated contrast enhancement along with severe canal stenosis and disc herniations at T6-T9. Brain MRI showed no evidence of sarcoid involvement. Serum ACE and inflammatory markers were elevated. Patient was treated with high-dose IV steroids, leading to symptom improvement and decreased cord edema. Due to the concern for compressive myelopathy, the patient underwent decompression surgery with posterior fusion and laminectomy. However, a follow-up MRI a month post-surgery showed worsening edema. Patient was subsequently restarted on steroids as well as immunotherapy for treatment of neurosarcoidosis.

Conclusions This case underscores the diagnostic complexity of sarcoid myelitis versus compressive myelopathy. MRI spine findings suggested an inflammatory process consistent with neurosarcoidosis given the expansive nature of the spinal cord and resolution of edema and symptoms after steroids. However, the lack of CNS lesions in the brain and corresponding disc herniations at levels of edema/enhancement raised doubts of the neurosarcoidosis diagnosis. Given the risk of delaying treatment, the decision was made to initiate treatment for neurosarcoidosis. This case highlights the need for a multidisciplinary approach in such intricate cases.

Authors/Disclosures
Nora Nikprelevic, MD, MBBS (Cleveland Clinic Weston) PRESENTER	Dr. Nikprelevic has nothing to disclose.
Paunel Agyei, MD	Dr. Agyei has nothing to disclose.
Paulina Birenbaum, DO (Cleveland Clinic Florida)	Dr. Birenbaum has nothing to disclose.

��ɫ��

��ɫ��