https://doi.org/10.1177/1352458518771518 https://doi.org/10.1177/1352458518771518 MULTIPLE SCLEROSIS MSJ JOURNAL journals.sagepub.com/home/msj 1 Multiple Sclerosis Journal 1–4 DOI: 10.1177/ 1352458518771518 © The Author(s), 2018. Reprints and permissions: http://www.sagepub.co.uk/ journalsPermissions.nav Introduction Spinal neurosarcoidosis (NS) is a rare presentation of NS which typically affects cranial nerves, base of the brain, or meninges. Diagnosis of isolated spinal NS can be challenging as its clinical manifestations can be indistinguishable from other causes of transverse myelitis. In addition, the imaging findings in spinal NS can mimic the longitudinally extensive transverse myelitis (LETM) seen in neuromyelitis optica (NMO) and other disorders. 1,2 The lack of characteristic clinical or imaging findings leads to difficulty in distinguishing spinal NS from other conditions, often requiring biopsy for diagno- sis. 3 We present a series of three patients presenting with LETM and concurrent spinal nerve root enhance- ment due to NS. We believe that this combination of central nervous system (CNS) and peripheral nervous system (PNS) involvement on spinal imaging may be a unique feature of spinal NS. Materials and methods Cases were collected retrospectively from chart review from 2011 to 2014. Case 1 A 48-year-old man presented with several weeks of lower back pain radiating into both legs. Examination revealed lower extremity hyperreflexia and asymmet- ric bilateral lower extremity weakness. Cerebrospinal fluid (CSF) studies were notable for 356 mm 3 nucle- ated cells with a 93% lymphocytic predominance. CSF protein was elevated at 806 mg/dL. Spinal mag- netic resonance imaging (MRI) revealed enhance- ment of the ventral pial surface of spinal cord in cervical region, and enhancement of nerve roots in cervical region with increased T2 signal along the ventral spinal cord from C2C6 and the upper thoracic region. In addition, there was avid enhancement of cauda equina at the level of the conus as well as descending portions of left L5 nerve root, demon- strated in Figure 1. He was treated with IV methylprednisolone for 5 days with improvement. Follow-up imaging 6 months later showed resolving inflammation of the cord. He went on to have several more bouts of myelitis before a biopsy of his cauda equina showed dense non-caseat- ing granulomas with T-cell dominant lymphohistio- cytic inflammation consistent with sarcoidosis. He was started on infliximab with no further events. Case 2 A 54-year-old woman presented with several months of numbness and tingling in both legs followed by gait unsteadiness. On examination, she was found to have Concurrent LETM and nerve root enhancement in spinal neurosarcoid: A case series Pojen Deng, Olga Krasnozhen-Ratush, Christopher William and Jonathan Howard Abstract: Spinal neurosarcoidosis is a rare form of neurosarcoid which can be challenging to diagnose given its clinical or radiographic findings are often indistinguishable from other causes of spinal demye- linating disease. We present a series of three patients with spinal neurosarcoid, all of whom demonstrated concurrent longitudinally enhancing transverse myelitis as well as spinal nerve root enhancement. These findings may be suggestive of spinal neurosarcoid and may help clinicians make the diagnosis as well as reduce the need for invasive biopsy. Keywords: Neurosarcoid, multiple sclerosis, demyelinating disease Date received: 14 August 2017; revised: 24 February 2018; accepted: 14 March 2018 Correspondence to: P Deng Department of Neurology, Icahn School of Medicine at Mount Sinai, 425 West 59th Street, Suite 6A, New York, NY 10019, USA. Pojen.Deng@mountsinai. org Pojen Deng Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA Olga Krasnozhen-Ratush Christopher William Department of Pathology, NYU Langone Medical Center, New York, NY, USA Jonathan Howard Department of Neurology, NYU Langone Medical Center, New York, NY, USA 771518MSJ 0 0 10.1177/1352458518771518Multiple Sclerosis JournalP Deng, O Krasnozhen-Ratush case-report 2018 Case Report