Intramedullary neurosarcoidosis in the medulla oblongata: a case report.
OBJECTIVE
We present a rare case of neurosarcoidosis mimicking an intramedullary tumor in the medulla oblongata. The features of the clinical presentation, magnetic resonance (MRI) appearances, and management strategy are discussed.


METHODS
A 59-year-old man without evidence of systemic sarcoidosis was presented with a history of progressive numbness and deep sensation disturbance in bilateral lower extremities. MR imaging revealed an enhanced intra-axial mass lesion on the dorsal side of medulla. Under neurophysiological monitoring, tumor biopsy was performed. Pathologic evaluation revealed noncaseating granuloma composed of large epithelioid cells with multinucleated giant cells, suggesting sarcoidosis. Findings of comprehensive hematologic laboratory studies; cerebrospinal fluid examination; and examinations for bacteria, fungi, and acid fast bacilli were all negative. This mass lesion was diagnosed as medullary neurosarcoidosis, and then high-dose steroid therapy was tried. On follow-up, nearly complete resolution of the neurosarcoidosis on MRI was revealed.


CONCLUSIONS
To our knowledge, this is the first reported case of neurosarcoidosis manifested in the medulla oblongata. A biopsy is sufficient for a diagnosis and high-dose steroid is recommended.
Department of Neurological Surgery, Aichi Medical University, Aichi, Japan.
Tjokorda G B
TG
Mahadewa
Hiroshi
H
Nakagawa
Takeya
T
Watabe
Tatsushi
T
Inoue
D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D001706:Biopsy; D001927:Brain Diseases / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D003287:Contrast Media; D003937:Diagnosis, Differential; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D019786:Gadolinium DTPA; D006801:Humans; D007089:Image Enhancement; D008279:Magnetic Resonance Imaging; D008297:Male; D008526:Medulla Oblongata / Q000473:pathology; D008875:Middle Aged; D009460:Neurologic Examination; D011239:Prednisolone / Q000008:administration & dosage; D012507:Sarcoidosis / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology
D000893:Anti-Inflammatory Agents; D003287:Contrast Media; D011239:Prednisolone; D019786:Gadolinium DTPA