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Lee KY, Khil EK, Lee SA, Lee JW, Lee E. Neurosarcoidosis involving cervical nerve root with unusual MRI findings: a case report and systematic literature review. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:2878-2885. [PMID: 38376559 DOI: 10.1007/s00586-024-08159-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 01/03/2024] [Accepted: 01/22/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND Neurosarcoidosis is rare, and among its manifestations, nerve root involvement has been reported in only a few cases. Therefore, magnetic resonance imaging (MRI) findings of neurosarcoidosis, particularly those involving nerve roots, are scarce in the literature. METHODS We presented the case of neurosarcoidosis involving cervical nerve roots and cranial nerves, alongside a systematic literature review. RESULTS A 28-year-old female suddenly developed right facial numbness as well as left upper extremity and left hand pain. Initial brain and spine MRI showed a bulging mass of T2 iso-to-high signal intensity in the left Meckel's cave/trigeminal nerve, as well as diffuse enlargement of the right C6 and C7 nerve roots. Follow-up MRI at 2 months revealed a reduction in the size of the initial lesion and the appearance of new similar lesions on the contralateral side (right Meckel's cave, left C3-C8 nerve roots). In particular, the lesions involving the nerve roots demonstrated central enlargement along the nerve roots, without involvement of the adjacent spinal cord. All these lesions exhibited enhancement, leading to the differentiation between sarcoidosis and lymphoma. Sarcoidosis was subsequently confirmed through biopsy of a hilar lymph node. CONCLUSIONS This report presents a distinctive MRI feature of neurosarcoidosis involving spinal nerve roots, representing the first of its kind, and describes the evolution of MRI findings throughout the clinical course.
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Affiliation(s)
- Kyoung Yeon Lee
- Department of Radiology, Hallym University Dongtan Sacred Heart Hospital, 7, Keunjaebong-gil, Hwaseong-si, Gyeonggi-do, Korea
| | - Eun Kyung Khil
- Department of Radiology, Hallym University Dongtan Sacred Heart Hospital, 7, Keunjaebong-gil, Hwaseong-si, Gyeonggi-do, Korea.
- Department of Radiology, Fastbone Orthopedic Hospital, 127-27, Dongtansunhwan-daero, Hwaseong-si, Gyeonggi-do, Korea.
| | - Seun Ah Lee
- Department of Radiology, Hallym University Dongtan Sacred Heart Hospital, 7, Keunjaebong-gil, Hwaseong-si, Gyeonggi-do, Korea
| | - Joon Woo Lee
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, Korea
| | - Eugene Lee
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, Korea
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Matsuyoshi A, Uchiyama D, Kawanami T, Inamori Y, Shiraishi W. [A case of neurosarcoidosis initially diagnosed as cervical spondylotic myelopathy, leading to diagnosis by gadolinium contrast-enhanced MRI]. Rinsho Shinkeigaku 2024; 64:339-343. [PMID: 38658329 DOI: 10.5692/clinicalneurol.cn-001921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
A 70-year-old female presented with bilateral numbness in her upper limbs. She was diagnosed with cervical spondylotic myelopathy and underwent cervical laminoplasty. However, there was no significant improvement in sensory disturbance, and at 6 months after surgery, she developed subacute motor and gait disturbance in four extremities. Spinal MRI revealed a long lesion of the spinal cord with edema, and a part of the lesion showed gadolinium contrast enhancement. Bronchoscopy revealed an elevated CD4/8 ratio, and gallium scintigraphy demonstrated an accumulation in the hilar lymph nodes, leading to a diagnosis of neurosarcoidosis. In case of rapid deterioration during the course of cervical spondylotic myelopathy, neurosarcoidosis should be considered as a differential diagnosis, which can be assessed by contrast-enhanced MRI.
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Spinal cord sarcoidosis in Japan: utility of cerebrospinal fluid examination and nerve conduction study for diagnosis and prognosis prediction. J Neurol 2022; 269:4783-4790. [DOI: 10.1007/s00415-022-11113-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 03/28/2022] [Accepted: 03/29/2022] [Indexed: 10/18/2022]
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Nolte JYC, Ten Dam L, van de Beek D, Brouwer MC. Clinical characteristics and outcome of neurosarcoidosis associated myelitis: A retrospective cohort study and review of the literature. Eur J Neurol 2022; 29:1763-1770. [PMID: 35189010 PMCID: PMC9313795 DOI: 10.1111/ene.15295] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 02/15/2022] [Indexed: 11/28/2022]
Abstract
Background and purpose Neurosarcoidosis can affect all parts of the nervous system of which myelitis is relatively frequent. The aim of this study was to describe clinical characteristics, treatment and prognosis of patients with myelitis attributable to neurosarcoidosis. Methods We performed a retrospective cohort study and a systematic review and meta‐analysis of neurosarcoidosis‐associated myelitis. Results Myelitis was identified in 41 of 153 (27%) neurosarcoidosis patients seen at our clinic from 2015 to 2020. Classification of neurosarcoidosis was definite in three (7%), probable in 29 (71%) and possible in nine patients (22%). The median (interquartile range) age at onset was 49 (41–53) years and 20 of the patients were female (49%). The presenting symptoms included muscle weakness in 31 of 41 patients (78%), sensory loss in 35 (88%) and micturition abnormalities in 30 (75%). Spinal magnetic resonance imaging showed longitudinally extensive myelitis in 27 of 36 patients (75%) and cerebrospinal fluid examination showed an elevated leukocyte count in 21 patients (81%). Initial treatment consisted of glucocorticoids in 38 of 41 patients (93%), with additional methotrexate or azathioprine in 21 of 41 patients (51%) and infliximab in 10 of 41 patients (24%). Treatment led to remission, improvement or stabilization of disease in 37 of 39 patients (95%). Despite treatment, 18 of 30 patients (60%) could not walk independently at the end of follow‐up (median 36 months). A review of the literature published between 2000 and 2020 identified 215 patients with comparable clinical characteristics and results of ancillary investigations. Conclusion Sarcoidosis‐associated myelitis is observed in 27% of neurosarcoidosis patients. Although treatment often led to a decrease in disease activity, residual neurological deficits leading to loss of ambulation occurred frequently.
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Affiliation(s)
- Jessica Y C Nolte
- Department of Neurology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Leroy Ten Dam
- Department of Neurology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Diederik van de Beek
- Department of Neurology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Matthijs C Brouwer
- Department of Neurology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
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Fracture of the Dens Axis Due to Spinal Manifestation of Sarcoidosis: Treatment Option and Review of the Literature. Spine (Phila Pa 1976) 2021; 46:E743-E749. [PMID: 34100842 DOI: 10.1097/brs.0000000000003992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Case report and literature review. OBJECTIVE We present a case of a pathologic unstable fracture of the odontoid process due to vertebral osseous sarcoidosis. The surgical management of this unreported pathology is described and a review of the literature is given. SUMMARY OF BACKGROUND DATA Sarcoidosis is a chronic inflammatory systemic disease of unknown etiology, characterized by multiorgan noncaseating granulomatous infiltrations. It affects primarily the lungs, lymphatic system, eyes, skin, heart, and nervous system. Osseous sarcoidosis is usually clinically asymptomatic and therefore frequently under-diagnosed. When it does affect the skull or vertebral column, specific surgical therapy is only necessary in cases with nonmanageable pain or where structural integrity is threatened. METHODS Our patient underwent a so-called semiconservative approach, consisting of a minimally invasive transoral-transpharyngeal approach, surgical debridement of the lytic bony lesion, transplantation of cancellous homologous bone, and carbon chest halo-immobilization. Halo-immobilization was left for 8 weeks, followed by a further 6 weeks with a hard cervical collar. RESULTS Routine computed tomography scans 3 days, 6, 12, 18 weeks, and 1 year after surgery showed good filling of the original defect with cancellous bone, correct alignment of the upper cervical spine, and progressive fracture consolidation and stability. Surgical site infection (SSI) was not observed. The patient had no neurological postoperative deficits. After initial dysphagia, swallowing was not permanently impaired. CONCLUSION Sarcoidosis-induced odontoid fractures can be managed successfully using a semiconservative approach, consisting of transoral-transmucosal, minimally invasive surgical procedure for debridement of the lesion and transplantation of cancellous bone with additional halo-immobilization. Permanent fusion of C1-2 with loss of the cervical range of motion is avoided. Despite performing bone surgery in a potentially markedly contaminated site, bacterial infection was not an issue, possibly supported by the temporary discontinuation of immunosuppressive agents and the prudent use of antibiotics.Level of Evidence: 4.
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Murphy OC, Salazar-Camelo A, Jimenez JA, Barreras P, Reyes MI, Garcia MA, Moller DR, Chen ES, Pardo CA. Clinical and MRI phenotypes of sarcoidosis-associated myelopathy. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2020; 7:e722. [PMID: 32269072 PMCID: PMC7176244 DOI: 10.1212/nxi.0000000000000722] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 02/28/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To determine the characteristic clinical and spinal MRI phenotypes of sarcoidosis-associated myelopathy (SAM), we analyzed a large cohort of patients with this disorder. METHODS Patients diagnosed with SAM at a single center between 2000 and 2018 who met the established criteria for definite and probable neurosarcoidosis were included in a retrospective analysis to identify clinical profiles, CSF characteristics, and MRI lesion morphology. RESULTS Of 62 included patients, 33 (53%) were male, and 30 (48%) were African American. SAM was the first clinical presentation of sarcoidosis in 49 patients (79%). Temporal profile of symptom evolution was chronic in 81%, with sensory symptoms most frequently reported (87%). CSF studies showed pleocytosis in 79% and CSF-restricted oligoclonal bands in 23% of samples tested. Four discrete patterns of lesion morphology were identified on spine MRI: longitudinally extensive myelitis (n = 28, 45%), short tumefactive myelitis (n = 14, 23%), spinal meningitis/meningoradiculitis (n = 14, 23%), and anterior myelitis associated with areas of disc degeneration (n = 6, 10%). Postgadolinium enhancement was seen in all but 1 patient during the acute phase. The most frequent enhancement pattern was dorsal subpial enhancement (n = 40), followed by meningeal/radicular enhancement (n = 23) and ventral subpial enhancement (n = 12). In 26 cases (42%), enhancement occurred at locations with coexisting structural changes (e.g., spondylosis). CONCLUSIONS Recognition of the clinical features (chronically evolving myelopathy) and distinct MRI phenotypes (with enhancement in a subpial and/or meningeal pattern) seen in SAM can aid diagnosis of this disorder. Enhancement patterns suggest that SAM may have a predilection for areas of the spinal cord susceptible to mechanical stress.
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Affiliation(s)
- Olwen C Murphy
- From the Division of Neuroimmunology (O.C.M., A.S.-C., J.A.J., P.B., M.I.R., M.A.G., C.A.P.), Johns Hopkins Myelitis and Myelopathy Center, Johns Hopkins Hospital; and Division of Pulmonary and Critical Care Medicine (D.R.M., E.S.C.), Johns Hopkins Hospital, Baltimore, MD
| | - Andrea Salazar-Camelo
- From the Division of Neuroimmunology (O.C.M., A.S.-C., J.A.J., P.B., M.I.R., M.A.G., C.A.P.), Johns Hopkins Myelitis and Myelopathy Center, Johns Hopkins Hospital; and Division of Pulmonary and Critical Care Medicine (D.R.M., E.S.C.), Johns Hopkins Hospital, Baltimore, MD
| | - Jorge A Jimenez
- From the Division of Neuroimmunology (O.C.M., A.S.-C., J.A.J., P.B., M.I.R., M.A.G., C.A.P.), Johns Hopkins Myelitis and Myelopathy Center, Johns Hopkins Hospital; and Division of Pulmonary and Critical Care Medicine (D.R.M., E.S.C.), Johns Hopkins Hospital, Baltimore, MD
| | - Paula Barreras
- From the Division of Neuroimmunology (O.C.M., A.S.-C., J.A.J., P.B., M.I.R., M.A.G., C.A.P.), Johns Hopkins Myelitis and Myelopathy Center, Johns Hopkins Hospital; and Division of Pulmonary and Critical Care Medicine (D.R.M., E.S.C.), Johns Hopkins Hospital, Baltimore, MD
| | - Maria I Reyes
- From the Division of Neuroimmunology (O.C.M., A.S.-C., J.A.J., P.B., M.I.R., M.A.G., C.A.P.), Johns Hopkins Myelitis and Myelopathy Center, Johns Hopkins Hospital; and Division of Pulmonary and Critical Care Medicine (D.R.M., E.S.C.), Johns Hopkins Hospital, Baltimore, MD
| | - Maria A Garcia
- From the Division of Neuroimmunology (O.C.M., A.S.-C., J.A.J., P.B., M.I.R., M.A.G., C.A.P.), Johns Hopkins Myelitis and Myelopathy Center, Johns Hopkins Hospital; and Division of Pulmonary and Critical Care Medicine (D.R.M., E.S.C.), Johns Hopkins Hospital, Baltimore, MD
| | - David R Moller
- From the Division of Neuroimmunology (O.C.M., A.S.-C., J.A.J., P.B., M.I.R., M.A.G., C.A.P.), Johns Hopkins Myelitis and Myelopathy Center, Johns Hopkins Hospital; and Division of Pulmonary and Critical Care Medicine (D.R.M., E.S.C.), Johns Hopkins Hospital, Baltimore, MD
| | - Edward S Chen
- From the Division of Neuroimmunology (O.C.M., A.S.-C., J.A.J., P.B., M.I.R., M.A.G., C.A.P.), Johns Hopkins Myelitis and Myelopathy Center, Johns Hopkins Hospital; and Division of Pulmonary and Critical Care Medicine (D.R.M., E.S.C.), Johns Hopkins Hospital, Baltimore, MD
| | - Carlos A Pardo
- From the Division of Neuroimmunology (O.C.M., A.S.-C., J.A.J., P.B., M.I.R., M.A.G., C.A.P.), Johns Hopkins Myelitis and Myelopathy Center, Johns Hopkins Hospital; and Division of Pulmonary and Critical Care Medicine (D.R.M., E.S.C.), Johns Hopkins Hospital, Baltimore, MD.
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Soni N, Bathla G, Pillenahalli Maheshwarappa R. Imaging findings in spinal sarcoidosis: a report of 18 cases and review of the current literature. Neuroradiol J 2018; 32:17-28. [PMID: 30311851 DOI: 10.1177/1971400918806634] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Spinal sarcoidosis, referring to involvement of the spine in sarcoidosis, is relatively rare and may mimic other neurological disease affecting the spine. The authors present a clinic radiological review of 18 spinal sarcoidosis patients who presented to a tertiary hospital, with emphasis on initial imaging and radiological response to treatment. MATERIALS AND METHODS We retrospectively reviewed our departmental imaging archives over a 15-year period and found 49 cases of neurosarcoidosis out of which 18 patients had spinal magnetic resonance imaging. RESULTS Approximately 72% (13/18) of the neurosarcoidosis patients showed some form of spinal involvement. The clinical, epidemiological and imaging data were reviewed for these 13 patients at presentation and follow-up. The findings on magnetic resonance imaging included leptomeningeal enhancement (61%), pachymeningeal (23%), intramedullary enhancing lesions (38%) and bony involvement (15%). The cervical segment was most frequently involved followed by the thoracic segment. Involvement was often long segment (4.2 spinal segments) with proclivity for the dorsal cord. Mean follow-up was 23.2 months. A complete or near-complete radiological response occurred in 66% while partial response was seen in 25% patients. Four patients had isolated central nervous system involvement including one with isolated spinal cord involvement. On diffusion-weighted imaging, the apparent diffusion coefficient of intramedullary lesions was increased compared to normal-appearing cord on baseline and subsequent follow-up scans. CONCLUSIONS Spinal sarcoidosis was previously considered uncommon but is being increasingly recognized with widespread use of magnetic resonance imaging. Proclivity for dorsal surface involvement is characteristic, although not necessarily pathognomonic. Also, quantitative diffusion studies may serve as a biomarker for the disease activity and parenchymal injury.
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Affiliation(s)
- Neetu Soni
- Neuroradiology Department, University of Iowa Hospitals and Clinics, USA
| | - Girish Bathla
- Neuroradiology Department, University of Iowa Hospitals and Clinics, USA
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Durel CA, Marignier R, Maucort-Boulch D, Iwaz J, Berthoux E, Ruivard M, André M, Le Guenno G, Pérard L, Dufour JF, Turcu A, Antoine JC, Camdessanche JP, Delboy T, Sève P. Clinical features and prognostic factors of spinal cord sarcoidosis: a multicenter observational study of 20 BIOPSY-PROVEN patients. J Neurol 2016; 263:981-990. [PMID: 27007482 DOI: 10.1007/s00415-016-8092-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 03/07/2016] [Accepted: 03/08/2016] [Indexed: 11/30/2022]
Abstract
Sarcoidosis of the spinal cord is a rare disease. The aims of this study are to describe the features of spinal cord sarcoidosis (SCS) and identify prognostic markers. We analyzed 20 patients over a 20-year period in 8 French hospitals. There were 12 men (60 %), mostly Caucasian (75 %). The median ages at diagnosis of sarcoidosis and myelitis were 34.5 and 37 years, respectively. SCS revealed sarcoidosis in 12 patients (60 %). Eleven patients presented with motor deficit (55 %) and 9 had sphincter dysfunction (45 %). The median initial Edmus Grading Scale (EGS) score was 2.5. The cerebrospinal fluid (CSF) showed elevated protein level (median: 1.00 g/L, interquartile range (IQR) 0.72-1.97), low glucose level (median 2.84 mmol/L, IQR 1.42-3.45), and elevated white cell count (median 22/mm(3), IQR 6-45). The cervical and thoracic cords were most often affected (90 %). All patients received steroids and an immunosuppressive drug was added in 10 cases (50 %). After a mean follow-up of 52.1 months (range 8-43), 18 patients had partial response (90 %), 7 displayed functional impairment (35 %), and the median final EGS score was 1. Six patients experienced relapse (30 %). There was an association between the initial and the final EGS scores (p = 0.006). High CSF protein level showed a trend toward an association with relapse (p = 0.076). The spinal cord lesion was often the presenting feature of sarcoidosis. Most patients experienced clinical improvement with corticosteroids and/or immunosuppressive treatment. The long-term functional prognosis was correlated with the initial severity.
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Affiliation(s)
- Cécile-Audrey Durel
- Département de Médicine Interne, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 69004, Lyon, France. .,Université de Lyon, Université Lyon 1, 69100, Villeurbanne, France.
| | - Romain Marignier
- Département de Neurologie, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, 69500, Bron, France
| | - Delphine Maucort-Boulch
- Université de Lyon, Université Lyon 1, 69100, Villeurbanne, France.,Service de Biostatistique, Hospices Civils de Lyon, 69003, Lyon, France.,CNRS UMR 555, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique Santé, 69100, Villeurbanne, France
| | - Jean Iwaz
- Université de Lyon, Université Lyon 1, 69100, Villeurbanne, France.,Service de Biostatistique, Hospices Civils de Lyon, 69003, Lyon, France.,CNRS UMR 555, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique Santé, 69100, Villeurbanne, France
| | - Emilie Berthoux
- Département de Médicine Interne, CH Saint Luc Saint Joseph, 69007, Lyon, France
| | - Marc Ruivard
- Département de Médecine Interne, CHU de Clermont-Ferrand, CHU Estaing, 63003, Clermont-Ferrand, France
| | - Marc André
- Service de Médecine Interne, CHU Clermont-Ferrand, Hôpital Gabriel Montpied, 63003, Clermont-Ferrand, France
| | - Guillaume Le Guenno
- Département de Médecine Interne, CHU de Clermont-Ferrand, CHU Estaing, 63003, Clermont-Ferrand, France
| | - Laurent Pérard
- Département de Médecine Interne, Hôpital Edouard Herriot, Hospices Civils de Lyon, 69008, Lyon, France
| | - Jean-François Dufour
- Département de Médecine Interne, Centre hospitalier Fleyriat, 01012, Bourg-en-Bresse, France
| | - Alin Turcu
- Département de Médecine Interne et Maladies Systémiques, CHU Dijon, 21079, Dijon, France
| | - Jean-Christophe Antoine
- Département de Neurologie, CHU de Saint-Etienne, Hôpital Nord, 42055, Saint Etienne Cedex 022, France
| | | | - Thierry Delboy
- Département de Médecine Interne, CH Montluçon, 03100, Montluçon, France
| | - Pascal Sève
- Département de Médicine Interne, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 69004, Lyon, France.,Université de Lyon, Université Lyon 1, 69100, Villeurbanne, France
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Flanagan EP, Kaufmann TJ, Krecke KN, Aksamit AJ, Pittock SJ, Keegan BM, Giannini C, Weinshenker BG. Discriminating long myelitis of neuromyelitis optica from sarcoidosis. Ann Neurol 2016; 79:437-47. [PMID: 26677112 DOI: 10.1002/ana.24582] [Citation(s) in RCA: 113] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 12/01/2015] [Accepted: 12/13/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To compare longitudinally extensive myelitis in neuromyelitis optica spectrum disorders (NMOSD) and spinal cord sarcoidosis (SCS). METHODS We identified adult patients evaluated between 1996 and 2015 with SCS or NMOSD whose first myelitis episode was accompanied by a spinal cord lesion spanning ≥3 vertebral segments. All NMOSD patients were positive for aquaporin-4-immunoglobulin G, and all sarcoidosis cases were pathologically confirmed. Clinical characteristics were evaluated. Spine magnetic resonance imaging was reviewed by 2 neuroradiologists. RESULTS We studied 71 patients (NMOSD, 37; SCS, 34). Sixteen (47%) SCS cases were initially diagnosed as NMOSD or idiopathic transverse myelitis. Median delay to diagnosis was longer for SCS than NMOSD (5 vs 1.5 months, p < 0.01). NMOSD myelitis patients were more commonly women, had concurrent or prior optic neuritis or intractable vomiting episodes more frequently, had shorter time to maximum deficit, and had systemic autoimmunity more often than SCS (p < 0.05). SCS patients had constitutional symptoms, cerebrospinal fluid (CSF) pleocytosis, and hilar adenopathy more frequently than NMOSD (p < 0.05); CSF hypoglycorrhachia (11%, p = 0.25) and elevated angiotensin-converting enzyme (18%, p = 0.30) were exclusive to SCS. Dorsal cord subpial gadolinium enhancement extending ≥2 vertebral segments and persistent enhancement >2 months favored SCS, and ringlike enhancement favored NMOSD (p < 0.05). Maximum disability was similar in both disorders. INTERPRETATION SCS is an under-recognized cause of longitudinally extensive myelitis that commonly mimics NMOSD. We identified clinical, laboratory, systemic, and radiologic features that, taken together, help discriminate SCS from NMOSD.
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Affiliation(s)
| | | | | | | | - Sean J Pittock
- Department of Neurology, Mayo Clinic, Rochester, MN.,Laboratory Medicine, Mayo Clinic, Rochester, MN
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Toledano M, Weinshenker BG, Solomon AJ. A Clinical Approach to the Differential Diagnosis of Multiple Sclerosis. Curr Neurol Neurosci Rep 2015; 15:57. [DOI: 10.1007/s11910-015-0576-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Wegener S, Linnebank M, Martin R, Valavanis A, Weller M. Clinically Isolated Neurosarcoidosis: A Recommended Diagnostic Path. Eur Neurol 2014; 73:71-7. [DOI: 10.1159/000366199] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 07/29/2014] [Indexed: 11/19/2022]
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