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Heterogeneity of myelopathy in patients with systemic sarcoidosis

https://doi.org/10.14412/2074-2711-2020-3-30-36

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Abstract

Myelopathy occurs in 1% of patients with sarcoidosis and is usually caused by the underlying disease. Comorbidity as its possible cause should be excluded, especially in a case of atypical neurosarcoidosis.

Objective: to analyze the features of myelopathy in patients with systemic sarcoidosis

Patients and methods. Twelve patients (7 women and 5 men) aged 41.5 [32.5; 45.3] years with systemic sarcoidosis and myelopathy were examined. The clinical and radiographic features of spinal cord (SC) injury and the nature of changes in laboratory parameters were analyzed.

Results and discussion. The cause of myelopathy was sarcoidosis (neurosarcoidosis (NS)) in 7 (58%) patients (Group 1) and multiple sclerosis in 4 (33%) (Group 2). One more patient developed myopathy due to extradural lipomatosis (this case is described in the clinical observation section). In Group 1, myelopathy was the first manifestation of sarcoidosis in 4 (57%) of the 7 patients. Six (86%) patients were observed to have incomplete regression of symptoms; 5 (71%) showed a progressive course. Magnetic resonance imaging (MRI) revealed the signs of a lesion in the thoracic SC in 4 (57%) patients with NS, as well as damage to three or more of its segments in 5 (71%) and a radiological pattern of sarcoidosis-induced SC lesion in 6 (86%). MRI findings showed that all the 4 (100%) patients in Group 2 had cervical SC injury, no patterns typical of NS, as well as the signs of meningeal contrast agent accumulation. None of them displayed pleocytosis and low glucose levels in the cerebrospinal fluid. Extradural lipomatosis-induced myelopathy was compressive with positive changes after discontinuation of glucocorticoids.

Conclusion. It is necessary to take into account the possibility of comorbidity as a cause of myelopathy in patients with sarcoidosis and the likelihood of SC lesion as a complication of therapy for the underlying disease.

About the Authors

V. S. Krasnov
Acad. I.P. Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia
Russian Federation

Vladimir Sergeevich Krasnov.

6—8, Lev Tolstoy St., Saint Petersburg 197022.



V. V. Zuykova
Acad. I.P. Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia
Russian Federation

6—8, Lev Tolstoy St., Saint Petersburg 197022.



E. V. Bubnova
Acad. I.P. Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia
Russian Federation

6—8, Lev Tolstoy St., Saint Petersburg 197022.



O. P. Baranova
Acad. I.P. Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia
Russian Federation

6—8, Lev Tolstoy St., Saint Petersburg 197022.



A. A. Skoromets
Acad. I.P. Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia
Russian Federation

6—8, Lev Tolstoy St., Saint Petersburg 197022.



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For citation:


Krasnov V.S., Zuykova V.V., Bubnova E.V., Baranova O.P., Skoromets A.A. Heterogeneity of myelopathy in patients with systemic sarcoidosis. Neurology, Neuropsychiatry, Psychosomatics. 2020;12(3):30-36. (In Russ.) https://doi.org/10.14412/2074-2711-2020-3-30-36

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ISSN 2074-2711 (Print)
ISSN 2310-1342 (Online)