Abstract Details

Title First Case of an Anterior Spinal Artery Stroke in Neurosarcoidosis: A case report and review of literature

Topic Autoimmune Neurology

Presentation(s) P15 - Poster Session 15 (12:00 PM-1:00 PM)

Poster/Presentation
Number 15-003

Objective NA

Background Sarcoidosis is a systemic granulomatous disorder that involves the nervous system in 5-15% of cases. Cerebrovascular manifestations of neurosarcoidosis are extremely rare with only 55 cases described in the literature. Seventy percent of strokes in neurosarcoidosis are ischemic. We present the first case of sarcoidosis causing an ischemic stroke in the anterior spinal artery (ASA).

Design/Methods A 67-year-old African American man with a history of multisystem sarcoidosis (pituitary, hilar nodes, liver and eyes) presented with acute worsening of a slowly progressive gait disturbance of 2 years duration. The initial examination showed spastic paraparesis and impaired vibration sense in the lower extremities with generalized hyperreflexia. MRIs of the neuroaxis showed an enhancing cord lesion at T9-T11, normal cervical cord and normal brain. Three days later, he became quadriplegic. Repeat Cervical Spine and Brain MRIs showed diffusion restriction in the ASA territory of the medulla extending to the upper cervical cord without meningeal or parenchymal enhancement. CTA of the Head/Neck did not show a large vessel occlusion. Serum ACE level was elevated. Extensive inflammatory workup and CSF analysis was negative. He was diagnosed with an ASA infarct due to sarcoidosis and treated with pulse steroids and immunosuppressive therapy. He recovered partial strength in his UEs only.

Results The mechanism of stroke in neurosarcoidosis is thought to be due to transmural inflammation of medium and small sized arteries; other proposed etiologies include large vessel vasculitis, embolization from cardiac sarcoidosis and basilar meningitis encroaching on penetrating arteries. One study mentioned that about half (20/43) patients were left with sequelae. The treatment of patients with neurosarcoidosis should be aggressive immunosuppresive therapy.

Conclusions Cerebrovascular events in patients with sarcoidosis are rare but should be suspected when patients present with acute worsening. Treatment should include regular stroke care in addition to aggressive immunosuppression.

Authors/Disclosures
Nirav Sanghani, MBBS (St. Francis Hospital and Medical Center) PRESENTER	Dr. Sanghani has nothing to disclose.
Machteld E. Hillen, MD, F�鶹��ýӳ�� (Rutgers-NJMS)	The institution of Dr. Hillen has received research support from Genentech.

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