Diffuse leptomeningeal enhancement in neurosarcoidosis-related longitudinally extensive myelitis

Realce leptomeníngeo difuso na mielite longitudinalmente extensa relacionada à neurossarcoidose

A 35-year-old man presented with a 1-month history of bilateral lower limb weakness and numbness. On examination, he had paraparesis with lower limbs hyperreflexia, and T5 sensory level. Magnetic resonance imaging (MRI) of the spine revealed a longitudinally extensive myelitis (LETM) with a diffuse leptomeningeal enhancement (Figure 1). Thorax computed tomography (CT) disclosed bilateral hilar lymphadenopathy. A transbronchial lymph node fine-needle biopsy revealed noncaseating granulomas. Considering this finding, probable neurosarcoidosis was diagnosed.

Figure 1
T2-weighted (A) image of the cervical spine demonstrates a longitudinally extensive myelitis (between the dashed lines). Contrast-enhanced T1-weighted (B) image with an extensive posterior spinal enhancement (arrow), and an anterior meningeal enhancement (arrowhead). Contrast-enhanced T1-weighted (C) of the thoracic spine disclosing an extensive posterior leptomeningeal enhancement (arrowheads), and (D) a circumferential involvement of the thoracic leptomeninges (arrowhead).

Leptomeningeal involvement is a remarkable finding in neurosarcoidosis.¹ When central nervous system (CNS) involvement occurs concomitantly with a widespread leptomeningeal enhancement, sarcoidosis should be considered as a possible differential diagnosis.²

References

• ¹
  Murphy OC, Salazar-Camelo A, Jimenez JA, et al. Clinical and MRI phenotypes of sarcoidosis-associated myelopathy. Neurology(R) neuroimmunology & neuroinflammation. NLM (Medline); 2020:7
• ²
  Dutra LA, Braga-Neto P, Oliveira RA, Pedroso JL, Abrahão A, Barsottini OGP. Neurosarcoidosis: guidance for the general neurologist. Arq Neuropsiquiatr 2012;70(04):293–299. Doi: 10.1590/s0004-282x2012000400014
  » https://doi.org/10.1590/s0004-282x2012000400014

Publication Dates

• Publication in this collection
  18 Dec 2023
• Date of issue
  2023

History

• Received
  18 Apr 2023
• Accepted
  03 May 2023