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Clinicoradiological dissociation in sarcoid myelopathy
  1. Roshan Dhanapalaratnam1,
  2. William Huynh1,2,3
  1. 1 Institute of Neurological Sciences, Prince of Wales Hospital, Sydney, New South Wales, Australia
  2. 2 Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
  3. 3 Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
  1. Correspondence to Dr William Huynh, Brain and Mind Centre, Sydney, NSW 2050, Australia; william.huynh{at}

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More than half of patients with neurosarcoidosis present primarily with neurological symptoms, often with delayed diagnosis given the heterogeneous presentation of this granulomatous multisystem inflammatory disorder.1

We report two cases of neurosarcoidosis that illustrate the under-recognised dissociation between clinical and radiological features in patients with sarcoid myelopathy.

An otherwise well 70-year-old man presented with acute left ocular pain following an insidious 12-month history of mild paraesthesia in his distal extremities. Ophthalmological assessment demonstrated anterior uveitis. Neurological examination revealed reduction to sensation in a glove-and-stocking distribution to the wrists and ankles and absent ankle jerks. There was no weakness or upper motor neuron features.

Electrophysiological assessment demonstrated markedly reduced sensory responses in the upper and lower limbs with preserved motor responses consistent with a generalised axonal sensory neuropathy. MRI of the brain and spinal cord revealed significant T2-hyperintensity and enhancement of the central canal of the cord at C4–5 (figure 1A,B), without concurrent intracranial lesions. The patient’s neurological presentation was deemed to be secondary to the generalised peripheral sensory neuropathy rather than the cord abnormalities given the absence of myelopathic features clinically.

Figure 1

T2 sagittal (A) and axial (B) MRI sequence of the …

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  • Contributors RD collected all the required clinical data and documents and drafted the manuscript. WH was involved in the management of the patients described in the manuscript, obtained clinical and radiological and final editing of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article.

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