Background
Sarcoidosis, an idiopathic multisystem inflammatory disorder, involves the nervous system in as few as 5-15% of cases. We aim to detail how a rare case of intramedullary neurosarcoidosis spinal-cord lesion, present in less than 1% of sarcoidosis cases, presented with features mimicking a neoplasm.
Methods
Retrospective chart review was performed to obtain pertinent details regarding history and examination, pathological findings, and treatment course.
Case Presentation
We report a case of intramedullary sarcoidosis involving the cervical and thoracic spinal cord with syringomyelia, which presented as subacute neck pain, intermittent leg paresthesias, and difficult micturition. Historically, a spinal syrinx with concern for neoplasm has led surgeons to decompress the spinal cord for certain enhancing intramedullary lesions, which is unnecessary for neurosarcoidosis. Immunosuppressant treatment resulted in symptomatic resolution without the need for spinal cord biopsy or syrinx decompression in this case.
Conclusions
Expansile contrast-enhancing intramedullary lesions, most commonly neoplastic, may instead be non-neoplastic etiologies mimicking neoplastic features; therefore, it is the responsibility of any surgeon to maintain a broad differential diagnosis in the absence of a confirmed pathology.