Neurosarcoidosis Presenting With Diffuse Multinodular Pachymeningeal Enhancement in the Cervicothoracic Spine: A Case Report and Review of the Literature

Neurosarcoidosis, particularly in the absence of extra-neurologic systemic manifestations of sarcoidosis, is a challenging diagnosis that has a wide array of presentations. Most often presenting with cranial neuropathies, basilar meningitis or pituitary/hypothalamic dysfunction, isolated involvement of the spinal cord without cranial manifestations is exceptionally rare, often involving intramedullary lesions. Here, we present the unique case of a 64-year-old female with atypical neurosarcoidosis presenting with myelopathy from extra-dural nodules without other neurologic or systemic symptoms. Pathology results from the extra-dural nodules were consistent with a neurosarcoidosis diagnosis. This is the first case report in the literature to our knowledge of atypical neurosarcoidosis presenting as isolated intradural extramedullary nodules without cranial or systemic manifestations of sarcoid disease.