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CC BY 4.0 · Arq Neuropsiquiatr 2023; 81(11): 1016-1017
DOI: 10.1055/s-0043-1772604
Images in Neurology

Diffuse leptomeningeal enhancement in neurosarcoidosis-related longitudinally extensive myelitis

Realce leptomeníngeo difuso na mielite longitudinalmente extensa relacionada à neurossarcoidose
Fabiano Ferreira de Abrantes 
1   Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Neurologia e Neurocirurgia, São Paulo SP, Brazil.
,
Marianna Pinheiro Moraes de Moraes 
1   Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Neurologia e Neurocirurgia, São Paulo SP, Brazil.
,
José Luiz Pedroso 
1   Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Neurologia e Neurocirurgia, São Paulo SP, Brazil.
,
Orlando G. Barsottini 
1   Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Neurologia e Neurocirurgia, São Paulo SP, Brazil.
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A 35-year-old man presented with a 1-month history of bilateral lower limb weakness and numbness. On examination, he had paraparesis with lower limbs hyperreflexia, and T5 sensory level. Magnetic resonance imaging (MRI) of the spine revealed a longitudinally extensive myelitis (LETM) with a diffuse leptomeningeal enhancement ([Figure 1]). Thorax computed tomography (CT) disclosed bilateral hilar lymphadenopathy. A transbronchial lymph node fine-needle biopsy revealed noncaseating granulomas. Considering this finding, probable neurosarcoidosis was diagnosed.

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Figure 1 T2-weighted (A) image of the cervical spine demonstrates a longitudinally extensive myelitis (between the dashed lines). Contrast-enhanced T1-weighted (B) image with an extensive posterior spinal enhancement (arrow), and an anterior meningeal enhancement (arrowhead). Contrast-enhanced T1-weighted (C) of the thoracic spine disclosing an extensive posterior leptomeningeal enhancement (arrowheads), and (D) a circumferential involvement of the thoracic leptomeninges (arrowhead).

Leptomeningeal involvement is a remarkable finding in neurosarcoidosis.[1] When central nervous system (CNS) involvement occurs concomitantly with a widespread leptomeningeal enhancement, sarcoidosis should be considered as a possible differential diagnosis.[2]


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Conflict of Interest

The authors have no conflict of interest to declare.

Authors' Contributions

FFA, MPMM: conceptualization, writing – original draft, writing – review & editing; JLP, OGB: conceptualization, writing – review & editing.



Address for correspondence

Fabiano Ferreira de Abrantes

Publication History

Received: 18 April 2023

Accepted: 03 May 2023

Article published online:
13 October 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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Zoom Image
Figure 1 T2-weighted (A) image of the cervical spine demonstrates a longitudinally extensive myelitis (between the dashed lines). Contrast-enhanced T1-weighted (B) image with an extensive posterior spinal enhancement (arrow), and an anterior meningeal enhancement (arrowhead). Contrast-enhanced T1-weighted (C) of the thoracic spine disclosing an extensive posterior leptomeningeal enhancement (arrowheads), and (D) a circumferential involvement of the thoracic leptomeninges (arrowhead).