A Case of Suspected Neurosarcoidosis Evading Diagnosis With Cervical Biopsy

TL;DR

A 46-year-old woman with neurological symptoms was suspected of having neurosarcoidosis, but diagnosis remained unclear despite multiple tests and a spinal biopsy.

Contribution

This case highlights the diagnostic challenges and complications of neurosarcoidosis, emphasizing the need for a multidisciplinary approach.

Findings

A cervical spinal biopsy failed to confirm neurosarcoidosis despite clinical suspicion.

The case illustrates the difficulty in diagnosing neurosarcoidosis due to non-specific symptoms and lack of definitive tests.

Post-operative complications like suspected epidural abscess and cervical kyphosis occurred.

Abstract

Neurosarcoidosis is a rare manifestation of sarcoidosis, posing diagnostic challenges due to its varied clinical presentation and the lack of definitive diagnostic tests. We present a case of a 46-year-old African American female with progressive ascending bilateral sensory loss, weakness, and a bifrontal headache. Despite undergoing extensive diagnostic workup including cerebrospinal fluid analysis, neuroimaging, and bronchoscopic evaluation, a definitive diagnosis remained elusive. The patient underwent an open cervical spinal cord biopsy, which did not yield conclusive evidence of neurosarcoidosis. Subsequent complications included suspicion of an epidural abscess and post-operative cervical kyphosis. This case underscores the diagnostic dilemma and potential complications associated with the evaluation and management of neurosarcoidosis, highlighting the importance of a multidisciplinary approach in such cases.

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