Intraspinal sarcoidosis

Diagnosis and management

George 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 1997
Externally publishedYes

Fingerprint

Sarcoidosis
Cauda Equina
Spinal Cord
Spinal Cord Neoplasms
Pathology
Biopsy
Meninges
Laminectomy
Somatosensory Evoked Potentials
Gadolinium
Frozen Sections
Adrenal Cortex Hormones
Extremities
Magnetic Resonance Imaging
Neoplasms

Keywords

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

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Jallo, G., 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

Intraspinal sarcoidosis : Diagnosis and management. / Jallo, George; Zagzag, David; Lee, Mark; Deletis, Vedran; Morota, Nobu; Epstein, Fred J.

In: Surgical Neurology, Vol. 48, No. 5, 11.1997, p. 514-521.

Research output: Contribution to journalArticle

Jallo, G, Zagzag, D, Lee, M, Deletis, V, Morota, N & Epstein, FJ 1997, 'Intraspinal sarcoidosis: Diagnosis and management', Surgical Neurology, vol. 48, no. 5, pp. 514-521. https://doi.org/10.1016/S0090-3019(96)00440-5
Jallo G, Zagzag D, Lee M, Deletis V, Morota N, Epstein FJ. Intraspinal sarcoidosis: Diagnosis and management. Surgical Neurology. 1997 Nov;48(5):514-521. https://doi.org/10.1016/S0090-3019(96)00440-5
Jallo, George ; Zagzag, David ; Lee, Mark ; Deletis, Vedran ; Morota, Nobu ; Epstein, Fred J. / Intraspinal sarcoidosis : Diagnosis and management. In: Surgical Neurology. 1997 ; Vol. 48, No. 5. pp. 514-521.
@article{04f82e7b0ff442bfa93684edae41379f,
title = "Intraspinal sarcoidosis: Diagnosis and management",
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.",
keywords = "Angiotensin converting enzyme, Cauda equina, Corticosteroid therapy, Evoked potentials, Intramedullary tumor, Sarcoidosis",
author = "George Jallo and David Zagzag and Mark Lee and Vedran Deletis and Nobu Morota and Epstein, {Fred J.}",
year = "1997",
month = "11",
doi = "10.1016/S0090-3019(96)00440-5",
language = "English (US)",
volume = "48",
pages = "514--521",
journal = "World Neurosurgery",
issn = "1878-8750",
publisher = "Elsevier Inc.",
number = "5",

}

TY - JOUR

T1 - Intraspinal sarcoidosis

T2 - Diagnosis and management

AU - Jallo, George

AU - Zagzag, David

AU - Lee, Mark

AU - Deletis, Vedran

AU - Morota, Nobu

AU - Epstein, Fred J.

PY - 1997/11

Y1 - 1997/11

N2 - 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.

AB - 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.

KW - Angiotensin converting enzyme

KW - Cauda equina

KW - Corticosteroid therapy

KW - Evoked potentials

KW - Intramedullary tumor

KW - Sarcoidosis

UR - http://www.scopus.com/inward/record.url?scp=0030784658&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0030784658&partnerID=8YFLogxK

U2 - 10.1016/S0090-3019(96)00440-5

DO - 10.1016/S0090-3019(96)00440-5

M3 - Article

VL - 48

SP - 514

EP - 521

JO - World Neurosurgery

JF - World Neurosurgery

SN - 1878-8750

IS - 5

ER -