Spinal cord sarcoidosis with intramedullary cyst formation

Abstract

We report a case of spinal cord sarcoidosis with surgically confirmed localized cyst formation and probably syringomyelia involving almost the entire spinal cord, an association which has not been documented previously. The magnetic resonance (MR) findings before and after gadolinium diethylenetriamine-pentaacetic acid (Gd-DTPA) are described. There has been only one previous report of the MR findings in histologically confirmed spinal cord sarcoidosis, and in this case Gd-DTPA was not given. A 49-year-old man presented with a 3-week history of progressive urinary hesitancy and weakness of both legs. Three years previously he was diagnosed as having sarcoidosis on the basis of bilateral hilar adenopathy on plain chest radiography, and a positive Kveim test. Ten months before this admission he had developed granulomatous uveitis. On initial examination there was moderate reduction of muscle power in all four limbs, whilst tone and co-ordination were normal. Reflexes were generally brisk, abdominal reflexes were absent, and there were bilateral extensor plantar responses. Vibration and joint position sensation were absent bilaterally in his feet, and there was a spinothalamic sensory level at C8 on the right and D6 on the left.