Intraspinal sarcoidosis: Diagnosis and management

George I. Jallo, David Zagzag, Mark Lee, Vedran Deletis, Nobu Morota, Fred J. Epstein

Research output: Contribution to journalArticle

Abstract

OBJECTIVE: Isolated intramedullary spinal cord or cauda equina involvement by sarcoidosis is quite rare. We report three patients with intraspinal sarcoidosis and absent systemic manifestations of the disease. The clinical presentation, operative management electrophysiologic studies, pathology, laboratory investigations, and current therapy are discussed with attention to the previous literature. METHODS: Two of the three patients had a preoperative diagnosis of a cervical intramedullary spinal cord tumor. The third patient had the preoperative diagnosis of an infectious process involving the cauda equina. Magnetic resonance imaging (MRI) with gadolinium did not suggest an inflammatory process. Intraoperative somatosensory evoked potential performed in two patients exhibited normal amplitudes, but a prolonged latency in seven out of eight extremities; with normal central conduction time suggesting peripheral or radicular in involvement. All three patients underwent laminectomy a and biopsy of the intraspinal pathology. RESULTS: Pathologic examination demonstrated sarcoidosis in all three patients. Intraoperative observations, intramedullary nodules, and thickening of the meninges were inconsistent with neoplasm and limited the surgical procedure to a biopsy. Frozen sections performed at two of the operations revealed an inflammatory process that confirmed the intraoperative observations. Postoperatively, the diagnostic work-up for all patients was negative for systemic manifestations. CONCLUSIONS: Isolated intraspinal sarcoidosis is a rare process. The current management for intramedullary spinal cord or cauda equina sarcoidosis is prolonged corticosteroids. The surgeon should not attempt complete resection if this granulomatous process is suspected.

Original languageEnglish (US)
Pages (from-to)514-521
Number of pages8
JournalSurgical neurology
Volume48
Issue number5
DOIs
StatePublished - Nov 1 1997
Externally publishedYes

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Keywords

  • Angiotensin converting enzyme
  • Cauda equina
  • Corticosteroid therapy
  • Evoked potentials
  • Intramedullary tumor
  • Sarcoidosis

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Jallo, G. I., Zagzag, D., Lee, M., Deletis, V., Morota, N., & Epstein, F. J. (1997). Intraspinal sarcoidosis: Diagnosis and management. Surgical neurology, 48(5), 514-521. https://doi.org/10.1016/S0090-3019(96)00440-5