Medcyclopaedia Home E-learningLibraryLexical IndexLexical TopicsGlossaryFace-a-CaseSpinal CordAcute disseminated encephalomyelitis (ADEM)Acute ischemic lesionAstrocytoma, case 1Astrocytoma, case 2Astrocytoma, case 3Astrocytoma, case 4Astrocytoma, case 5Astrocytoma, case 6Astrocytoma grade IIAstrocytoma, surgeryAVM, case 1AVM, case 2AVM, dural fistulaeCavernoma, case 1Cavernoma, case 2Cavernoma, case 3Cavernoma, case 4Cavernous angiomaDural fistula, case 1Dural fistula, case 2Dural fistula, case 3Ependymoma, case 1Ependymoma, case 2Ependymoma, case 3Ependymoma, case 4Ependymoma, case 5Ependymoma grade II, case 1Ependymoma grade II, case 2Ependymoma grade II, case 3Ependymoma grade II, case 4Ependymoma grade II, case 5Ependymoma grade II, case 6Ependymoma grade II, case 7Ependymoma grade II, case 8Ependymoma grade II, case 2Ependymoma grade II, case 10Epidermoid cyst, spinalGangliogliomaGlioblastoma grade IVHemangioblastoma, case 1Hemangioblastoma, case 2Hemangioblastoma, case 3Hemangioblastoma, case 4Hemangioblastoma, case 5Hemangioblastoma, surgeryHerpes myelitisHydatid cyst, spinal cordHydrosyringomyelia, case 1Hydrosyringomyelia, case 2Hydrosyringomyelia, case 3Hydrosyringomyelia, case 4Intramedullary- inflammatory lesionIntramedullary metastasisIschemic lesion in systemic lupus erythematosusLipoma, case 2LymphomaMetastasis, case 1Metastasis, case 2Metastasis, case 3Metastasis, case 4Multiple sclerosis, case 1Multiple sclerosis, case 2Multiple sclerosis, case 3Multiple sclerosis, case 4Multiple sclerosis, case 5Multiple sclerosis, case 6Multiple sclerosis, case 7Myxopapillary ependymoma grade I (WHO)Myxopapillary ependymoma of the conus, case 1Myxopapillary ependymoma of the conus, case 2Myxopapillary ependymomaof the conus, case 1Neurofibromatosis type IIOptic neuritis, Devic's syndrome in disseminated lupus erythematosus (SLE)Paraneoplastic encephalomyelitisPost-vaccination myelitisSarcoidosis, case 1Sarcoidosis, case 2SchwannomaSpinal cord schistosomiasisSpinal cord tuberculosisSubependymal ependymomaTancytic ependymoma grade II, case 1Tanycytic ependymoma grade II, case 2Tanycytic ependymoma grade II, case 3Transverse myelitis of unknown etiologyCerebral TumorsMR Neuro AngiographyTextbook of RadiologyTextbook of Radiology (e-paper)Medical Imaging Made EasyDownloadsMedcyclOasisAbout MedcyclopaediaContact Us
MedcycloPoll
Did you get the help you required from Medcyclopaedia™ during today's visit?
Yes
 
 (84.5%)
No
 
 (10.9%)
Undecided
 
 (4.6%)
You must be logged on to vote.
Please log in or register.
 
 
 

Sarcoidosis, case 1

 

Clinical history
This 58-year-old female first underwent surgery in 1988 for cervical spinal stenosis. A C2-C6 laminectomy was performed for spinal cord decompression. The dura was not opened at that time. The patient's clinical condition transiently improved, but six months after surgery the symptoms worsened, with progressive gait impairment and loss of strength in both hands.

Neurological examination revealed paresthesias of the left arm, bilateral loss of pain and temperature sensation at the level of C5-T1, and posterior cord type pain. McCormick grade II of disability and minor urinary disturbances were present.

Plain X-ray of the chest was normal and no systemic signs of sarcoidosis were present.

MRI
Image 1: Sagittal T1WI. The cervical spinal cord is enlarged at C2-C6, with inhomogeneous, slightly hypointense signal.
Images 2 - 3: Sagittal Gd T1WI show a focal patchy area of intense contrast enhancement within the spinal cord at the level of T3-T4.
Image 4: Axial T1WI confirms cord edema.
Image 5: Axial Gd T1WI demonstrates the precise location of the intramedullary zones of enhancement.

Surgery
Video 1.
During surgical re-exploration, an infiltrating mass lesion was found and biopsy revealed sarcoidosis.

Stage 1: General view - enlargement of the spinal cord
Stage 2: Opening of the spinal cord in the midline.
Stage 3: Separation of the posterior columns.
Stage 4: An infiltrating process is identified.
Stage 5: A cleavage plane cannot be found
Stage 6: Biopsy.
Stage 7: Debulking with CUSA (Cavitron Ultrasonic Surgical Aspirator).

Post-operative clinical course
The patient's neurological condition worsened immediately after surgery. The patient improved rapidly after corticosteroids were administered.

Post operative MRI (immediately after surgery)
Images 6 and 8: Sagittal and axial T1WI. Persistent enlargement of the spinal cord, heterogeneously decreased signal characteristics.
Images 7 and 9: Sagittal and axial Gd T1WI. Contrast enhancement is still identified at the C3-C4 level.

Search also:
- Sarcoidosis

 

The ESNR CD-Rom Series

To view high resolution images,
please register first.

Click  here to register.

Already registered? Enter your e-mail in the window below.
Re-register

Fig. 1

Sarcoidosis, case 1, Fig. 1
Sarcoidosis, case 1, Fig. 2
Sarcoidosis, case 1, Fig. 3
Sarcoidosis, case 1, Fig. 4
Sarcoidosis, case 1, Fig. 5
Sarcoidosis, case 1, Fig. 6
Sarcoidosis, case 1, Fig. 7
Sarcoidosis, case 1, Fig. 8
Sarcoidosis, case 1, Fig. 9