Spinal Sarcoidosis

(Pathogen free granulomatous disease of the spine)

05 November 2004

Neurosarcoidosis:         5% of  all sarcoidosis cases

                                    Generally cranial nerve palsy

Spinal sarcoidosis:        5-10% of all neurosarcoidosis

                                    Usually preceded by history of systemic sarcoidosis

                                    30 case reports to date

                                    behavior in spinal tissue is similar to intracranial involvement with

mass lesions less common than infiltrating granulomatous

processes

Diagnosis

SARCOIDOSIS IN GENERAL

CXR/ CT chest

Bronchoscopy with biopsy

Kveim test

Gallium scanning

Serum / 24 hour urinary calcium

NEUROSARCOIDOSIS

MRI with gadolinium:    90% sensitivity

CT:      mass lesions can appear slightly hyperdense & enhance homogenously

Serum ACE:     85% sensitivity for sarcoidosis (infrequently elevated in neurosarcoidosis)

CSF ACE:       rarely elevated in neurosarcoidosis

CSF:    increased protein – common but nonspecific

            Increased lymphocytes –           common

                                                            Increased T4/T8 in 75% of above

Reduced glucose – infrequent

            Oligoclonal banding – occasional

Biopsy: gold standard & exclude other diseases

NEUROSARCOIDOSIS VS PATHOGEN FREE GRANULOMATOUS DISEASE 

Differential Diagnosis

TB

Fungal

Zoster virus infection

Primary angiitis of CNS

Hematological malignancy (lymphoma, leukemia)

HIV myelopathy

Treatment

Operative intervention required: tissue diagnosis

                                                            Relief of progressive symptoms

Steroids as mainstay; dose & duration unknown

Other immunosuppressants: MTX, azathioprine, cyclophosphamide, cyclosporine