Document Detail

Intraspinal epidural sarcoidosis: case report.
MedLine Citation:
PMID:  8805157     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE AND IMPORTANCE: A rare case of lumbar intraspinal epidural sarcoidosis is identified. The rarity of this condition and its clinical presentation are stressed. CLINICAL PRESENTATION: A young Caucasian man presented with the progressive onset of cauda equina syndrome as a result of an expanding mass in the lumbar epidural space compromising the lumbar dural tube from L1 to S1. The patient presented with motor, sensory, and sphincteric dysfunction as a result of this large intraspinal epidural mass. No evidence of systemic illness was noted concomitant with the patient's onset of neurological symptomatology. The patient underwent surgical extirpation of a lumbar intraspinal epidural mass, which was identified histopathologically as sarcoid granuloma. The postoperative work-up included the identification of a mediastinal adenopathy, which was subsequently biopsied and confirmed the diagnosis of sarcoid disease. The patient was treated postoperatively with oral prednisone over a 4-month period. At 7 months postoperatively, the patient had regained gainful employment, the results of his neurological examination were normal, and he was pain-free. INTERVENTION: The patient underwent a multilevel bilateral lumbar laminectomy with facet preservation, extending from L1 to S1, allowing for a gross total removal of the epidural mass. Postoperative oral prednisone was administered as adjuvant therapy for the treatment of multisystem sarcoid disease. CONCLUSION: Aggressive surgical management involving the removal of an extensive epidural mass of the lumbar canal, which was diagnosed as sarcoid disease, coupled with the adjuvant use of oral prednisone has resulted in an excellent outcome for the patient. The results of his clinical examination are now normal, and postoperative radiological imaging reveals no evidence of recurrent or residual disease in the lumbar epidural space. In the unusual case of intraspinal epidural sarcoidosis, the surgical resection of accessible intraspinal epidural masses is recommended, as is the use of oral prednisone postoperatively.
M N Weissman; R Lange; C Kelley; K Belgea; L Abel
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Neurosurgery     Volume:  39     ISSN:  0148-396X     ISO Abbreviation:  Neurosurgery     Publication Date:  1996 Jul 
Date Detail:
Created Date:  1996-12-26     Completed Date:  1996-12-26     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  179-81     Citation Subset:  IM    
Department of Neurological Surgery, Wausau Hospital Medical Center, Wisconsin, USA.
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MeSH Terms
Combined Modality Therapy
Diagnosis, Differential
Epidural Space / pathology,  surgery
Neurologic Examination
Prednisone / administration & dosage
Sarcoidosis / diagnosis,  pathology,  surgery*
Spinal Cord Compression / diagnosis,  pathology,  surgery
Spinal Cord Diseases / diagnosis,  pathology,  surgery*
Reg. No./Substance:

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