Rinsho Shinkeigaku (Clinical Neurology)

Case Report

A case of neurosarcoidosis initially diagnosed as cervical spondylotic myelopathy, leading to diagnosis by gadolinium contrast-enhanced MRI

Ayano Matsuyoshi, M.D.1), Daiji Uchiyama, M.D., Ph.D.2), Toshinori Kawanami, M.D., Ph.D.3), Yukiko Inamori, M.D.1) and Wataru Shiraishi, M.D., Ph.D.1)

1) Department of Neurology, Kokura Memorial Hospital
2) Department of Radiology, Kokura Memorial Hospital
3) Department of Respiratory Medicine, Kokura Memorial Hospital

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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(CLINICA NEUROL, 64: 339−343, 2024)
key words: gadolinium contrast-enhanced MRI, cervical spondylotic myelopathy, sarcoidosis, longitudinal extensive lesion, vertebroplasty

(Received: 30-Aug-23)