H. Koike et al., Differential response to corticosteroid therapy of MRI findings and clinical manifestations in spinal cord sarcoidosis, J NEUROL, 247(7), 2000, pp. 544-549
Spinal cord sarcoidosis is a rare disorder whose natural history and therap
eutic outcome are not fully known. We examined four patients with spinal co
rd sarcoidosis both clinically and radiologically, particularly in relation
to corticosteroid treatment. The initial manifestation was cervical myelop
athy in three and uveitis in one. All four patients progressed slowly until
corticosteroid therapy was initiated. The cervical spine was involved in a
ll patients. Magnetic resonance imaging (MRI) who showed spinal cord swelli
ng with T2-weighted high intensity and linear leptomeningeal and patchy or
diffuse intramedullary enhancement with gadolinium diethylene triamine-pent
aacetic acid. With corticosteroid therapy, dramatic improvement was seen on
MRI, including disappearance or marked reduction of swelling and enhanceme
nt. Plasma levels of angiotensin-converting enzyme (ACE) were also markedly
improved. In contrast, the clinical symptoms were little improved in one p
atient, unchanged in two, and rather worsened in one patient. Recurrence wa
s seen on MRI at the maintenance dose in all four patients, without any dra
matic change in clinical manifestation. MRI findings and plasma ACE are wel
l correlated with active lesion of the spinal cord sarcoidosis, providing a
useful marker for recurrence, but do not parallel the clinical manifestati
ons.