{"id":"c0a77e21-4c42-4ddb-b752-814f102093b3","slug":"surgical-management-of-intramedullary-cervical-spinal-sarcoidosis-complicated-by-transient-unilateral-weakness-a-case-report","title":"Surgical management of intramedullary cervical spinal sarcoidosis complicated by transient unilateral weakness: A case report","authors":["Aziz Saade","Hayley M. Denwood","Tony Tannoury","Chadi Tannoury"],"abstract":"Background: Sarcoidosis, a multisystem inflammatory non-caseating granulomatous disease, can present with neurologic lesions in up to 10% of patients. Case Description: A 57-year-old male presented with three months of worsening upper extremity radicular pain associated with dysmetria, hyperreflexia, bilateral Hoffman’s, and positive Babinski signs. The contrast magnetic resonance imaging (MRI) showed a diffuse T2 signal hyperintensity and T1-enhancing 2.5 cm lesion extending sagittally between C4 and C6. The cerebrospinal fluid analysis showed a high protein level and lymphocytic pleocytosis. A cardiac positron emission tomography scan was consistent with the diagnosis of cardiac sarcoidosis. With the diagnosis of multisystemic/probable neurosarcoidosis, the patient was unsuccessfully treated with intravenous methylprednisolone, followed by infliximab. Due to severe cord compression/myelopathy, a C3–C6 laminectomy and C3–C7 posterior spinal fusion were performed. Postoperatively, the patient developed a transient right-sided hemiparesis. Over nine postoperative months, the patient had four relapses of transient repeated episodes of paresis, although follow-up cervical MRI scans revealed adequate cord decompression with a stable intramedullary hyperintense lesion. Conclusion: Patients with neurosarcoidosis respond unpredictably to surgical decompression and require prolonged medical care, which is often unsuccessful.","thumbnailUrl":"https://sni-digital-videos.s3.amazonaws.com/articles/c0a77e21-4c42-4ddb-b752-814f102093b3/featured/hero-1781559692139.png","publishDate":"2024-03-08T00:00:00.000Z","doi":"10.25259/SNI_41_2024","categories":["Spine","Case Report"],"fullTextUrl":"https://surgicalneurologyint.com/wp-content/uploads/2024/03/12790/SNI-15-76.pdf"}