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]
