Session Title: Neurological Rehabilitation Case and Research Report
Session Time: 11:15am-12:45pm
Location: Research Hub - Kiosk 5
Disclosures: Kevin A. Forster, DO: Nothing to disclose
Case Description: Sarcoidosis is an autoimmune disorder characterized by non-caseating granulomatous inflammation which can affect multiple systems. Neurologic involvement is uncommon, encompassing 5-15% of cases, with spinal cord involvement in < 1% of cases. This report describes a case of transverse myelitis caused by sarcoidosis causing Brown-Sequard syndrome.
Setting: Inpatient rehabilitation unit
Patient: 37-year-old African American woman with chronic back pain.
Assessment/Results: Patient initially presented 4 weeks prior to admission with thoracic back pain, left arm and bilateral foot paresthesias. MRI showed abnormality spanning the cervical and upper thoracic cord consistent with transverse myelitis. CSF showed pleocytosis. Infectious and autoimmune workups unrevealing, NMO IgG negative, IgG index normal. Prednisone taper was started with rapid resolution of symptoms. Patient returned 7 days later with progressive arm and leg weakness (left > right), decreased pinprick sensation R>L, neurogenic bowel and bladder. Repeat MRI showed progression of cord abnormality from foramen magnum to T4-T5. CT revealed a 3.2-cm left apical lung mass. High dose oral prednisone was started with improvement in left sided weakness and numbness, as well as resolution of right sided weakness. Neurological examination revealed C5 AIS D, partially preserved pinprick sensation (left > right). Muscle strength 5/5 in all key muscles on right side, C6 motor on left with 1/5 strength below level. Lung biopsy showed Non-necrotizing granulomatous inflammation consistent with sarcoidosis. Patient was diagnosed with transverse myelitis with Brown-Sequard syndrome, secondary to neurosarcoidosis.
Discussion: Mycophenolate mofetil was started and prednisone continued. Patient improved at discharge from inpatient rehabilitation. She was modified independent with bed mobility, wheelchair transfers, power wheelchair mobility. She had resolution of bowel dysfunction, but still required intermittent catheterization for bladder dysfunction.
Conclusion: Spinal cord involvement in sarcoidosis is an uncommon phenomenon. When considering underlying etiologies for transverse myelitis it is important that sarcoidosis is considered within the differential diagnosis.
Level of Evidence: Level IV
To cite this abstract in AMA style:Forster KA, Mckinley W, Valle FSD. Transverse Myelitis Secondary to Neurosarcoidosis Causing Brown-Sequard Syndrome [abstract]. PM R. 2019; 11(S2)(suppl 2). https://pmrjabstracts.org/abstract/transverse-myelitis-secondary-to-neurosarcoidosis-causing-brown-sequard-syndrome/. Accessed September 22, 2023.
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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/transverse-myelitis-secondary-to-neurosarcoidosis-causing-brown-sequard-syndrome/