Teaching NeuroImages: Spinal Neurosarcoidosis: An Eccentric Manifestation

A 56-year-old woman with a history of remote T11 traumatic spinal transection and residual paraplegia presented with subacute left arm pain, weakness, and sensory loss. MRI spine showed C4-7 patchy T2 cord signal and an eccentric enhancing focus with subpial involvement (figure 1). CSF studies were unremarkable, including negative oligoclonal bands. An extensive immunologic and infectious evaluation for subacute myelitis was unrevealing. However, given the subpial and intramedullary involvement in the spine,1,2 a systemic search for sarcoidosis was initiated. Asymptomatic hilar lymphadenopathy was diagnosed with CT chest, and a subsequent lymph node biopsy confirmed the clinical suspicion (figure 2). She was diagnosed with probable neurosarcoidosis1,2 and started on immunosuppresion.