gms | German Medical Science

Question: Clinical diagnosis of neurosarcoidosis is often delayed due to its heterogenous manifestations. Spinal cord involvement, radiculopathy, and peripheral neuropathy are rare. We present a patient with .findings of [18F]-fluorodeoxyglucose (F18-FDG) imaging visualizing a neurosarcoidosis.

Case report: A 37-year old woman complained of back pain, distal paraesthesia in all extremities, a feeling of pressure belt-shaped around her abdomen as well as facial palsy, unsteadiness and hearing impairment for weeks. Cerebral and lumbar MRI were found unsuspicious. The first CSF analysis showed a slight lymphocytic pleocytosis with elevated protein level. Initially neuroborreliosis was suspected, and treatment with ceftriaxone was initiated. The .first interpretation of the chest X-ray was judged to be normal. Seeking a tumour was ordered to rule out a paraneoplastic cause of the clinical syndrome. In order to use a very sensitive method for searching a malignant process of unknown origin, a F18-FDG PET/CT was performed. The result provided the cue to sarcoidosis with an increased tracer-uptake in mediastinal lymphnodes and additionally in lumbar spinal ganglia. The diameter of the enlarged lymph nodes amounted between 7.5 and 9 mm. At second glance the X-ray showed a slightly enhanced mediastinum. After suspected diagnosis of neurosarcoidosis was drawn, by following thoracic and abdominal CT-scanning as well as bronchoscopic biopsy a treatment regime with prednisolone was initiated, and symptoms were soon regressive.

Discussion: Our case clearly indicates that diagnosing neurosarcoidosis is often delayed, as the clinical symptoms are not specic and mimicking other neurological diseases such as neuroborreliosis. PET/CT is a superior method to come to a specific diagnosis and to start therapy immediately.