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Neeraj Kumar, MD; Elliot M. Frohman, MD, PhD

Arch Neurol. 2004;61:586-589.

Background  Intramedullary neurosarcoidosis may be the first and only manifestation of the disease and may mimic an idiopathic inflammatory demyelinating syndrome both clinically and on neuroimaging results.

Methods and Results  Two patients who were seen initially with a relapsing-remitting neurologic course and a cervical intramedullary lesion on magnetic resonance imaging findings are reported. Both proved to have neurosarcoidosis. A computed axial tomographic scan of the chest showed hilar adenopathy, which provided a clue to the diagnosis.

Conclusions  Symptoms due to an intramedullary cervical lesion can be the first manifestation of neurosarcoidosis. The clinical course can mimic a demyelinating illness. A high index of suspicion and a search for sarcoidosis at extraneural sites are required for an early diagnosis. Steroid treatment is associated with a favorable outcome.

From the Department of Neurology, Mayo Clinic, Rochester, Minn (Dr Kumar); and the Department of Neurology and Ophthalmology, The University of Texas Southwestern Medical Center at Dallas (Dr Frohman).