[A case of sarcoidosis with simultaneous involvement of the lower brainstem and the whole cervical cord and the extraocular muscles].
We report a 63-year-old woman with sarcoidosis which involved the spinal cord, lower brainstem and extraocular muscules simultaneously. In this patient, uveitis developed in 1991 and the skin lesion in 1992. A biopsy of the skin lesion showed changes consistent with sarcoidosis. The ocular and dermal symptoms improved with oral corticosteroid. In October 1997, she noted the left blepharoptosis and numbness of the hands. The MRI showed diffuse swelling of the lower brainstem and the cervical and upper thoracic cord. These lesions showed high intensity signal on T2WI and low intensity signal on T1WI. T1WI with contrast enhancement revealed localized enhancement within the spinal lesion at the C4/5 level. The ocular MRI showed swelling of the left superior rectus muscle and upper levator palpebral muscle. The steroid pulse therapy and subsequent oral administration of prednisolone markedly improved the clinical symptoms. MRI after treatment showed marked improvement of both the spinal cord and ocular muscle lesions. To our knowledge,  the simultaneous occurrence of myelopathy and symptomatic extraocular musculopathy in the condition has not been reported previously.
Hayashi
E
E
Department of Neurology, Mie University School of Medicine.
Niwa
A
A
Narita
Y
Y
Kuzuhara
S
S
D001927:Brain Diseases / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008526:Medulla Oblongata / Q000473:pathology*; D008875:Middle Aged; D009886:Ophthalmoplegia / Q000175:diagnosis / Q000209:etiology*; D012507:Sarcoidosis / Q000150:complications*; D013118:Spinal Cord Diseases / Q000175:diagnosis / Q000209:etiology*