Spinal cord sarcoidosis

Diagnostic

Gadolinium-enhanced MRI may reveal enhancing granulomatous tissue within either the meninges or cord. Any level of the cord may be involved, as may the conus and cauda equina.

In some patients, other parts of the central nervous system are affected, e.g. optic nerve, facial nerve, other cranial nerves, hypothalamus, brainstem, and cerebral hemispheres. Most, but not all, patients will have evidence of sarcoidosis outside of the nervous system.

Treatment

The mainstay of treatment is corticosteroids, initially in high doses. Long-term maintenance steroids may be required to prevent a relapse of cord or other central nervous system involvement. In patients who appear to be dependent on at least moderate doses of long-term maintenance steroids, some authorities recommend additional immunosuppressive therapy (e.g. methotrexate).