A 35-year-old man presented with a 1-month history of bilateral lower limb weakness and numbness. On examination, he had paraparesis with lower limbs hyperreflexia, and T5 sensory level. Magnetic resonance imaging (MRI) of the spine revealed a longitudinally extensive myelitis (LETM) with a diffuse leptomeningeal enhancement ([Figure 1]). Thorax computed tomography (CT) disclosed bilateral hilar lymphadenopathy. A transbronchial lymph node fine-needle biopsy revealed noncaseating granulomas. Considering this finding, probable neurosarcoidosis was diagnosed.
Figure 1 T2-weighted (A) image of the cervical spine demonstrates a longitudinally extensive myelitis (between the dashed lines). Contrast-enhanced T1-weighted (B) image with an extensive posterior spinal enhancement (arrow), and an anterior meningeal enhancement (arrowhead). Contrast-enhanced T1-weighted (C) of the thoracic spine disclosing an extensive posterior leptomeningeal enhancement (arrowheads), and (D) a circumferential involvement of the thoracic leptomeninges (arrowhead).
Leptomeningeal involvement is a remarkable finding in neurosarcoidosis.[1] When central nervous system (CNS) involvement occurs concomitantly with a widespread leptomeningeal enhancement, sarcoidosis should be considered as a possible differential diagnosis.[2]
