Nagai H, Ohtsubo K, Shimada H
Acta Pathol Jpn. 1985 Jul;35(4):1007-22.
The authors report a female elderly patient with quadriplegia, hypesthesia below the neck, and rectourinary dysfunction, which were found at autopsy to have been caused by involvement of the lower cervical and upper thoracic segments of the spinal cord in systemic sarcoidosis. Sixty cases of spinal cord sarcoidosis reported in the literature are also reviewed. Most patients had clinical signs which mimicked those of a spinal cord tumor or meningomyelitis. Only in less than one-third of the cases had sarcoidosis been diagnosed before neurological symptoms occurred. Macroscopically, most intramedullary lesions formed a mass, whereas extramedullary lesions usually manifested as meningitis. Histologically, perivascular distribution of sarcoid granulomas was noted in our patient as well as in many cases reported in the literature. The clinical course of the patients with spinal sarcoidosis was usually poor when early diagnosis was not made.
作者报告了一名老年女性患者，该患者出现四肢瘫痪、颈部以下感觉减退及直肠泌尿功能障碍，尸检发现这些症状是由系统性结节病累及脊髓下颈段和上胸段所致。本文还回顾了文献中报道的60例脊髓结节病病例。大多数患者的临床症状类似于脊髓肿瘤或脊膜炎。只有不到三分之一的病例在出现神经症状之前被诊断为结节病。宏观上，大多数髓内病变形成肿块，而髓外病变通常表现为脑膜炎。组织学上，在我们的患者以及文献报道的许多病例中都发现了结节样肉芽肿的血管周围分布。脊髓结节病患者若未早期诊断，临床病程通常较差。
