{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T07:41:28Z","timestamp":1788594088523,"version":"build-2803163510"},"reference-count":22,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2024,8,27]],"date-time":"2024-08-27T00:00:00Z","timestamp":1724716800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objective: To describe the clinical features and radiological outcomes of patients with spinal cord neurosarcoidosis, treatments, and long-term follow-up for this rare disorder. Methods: A cross-sectional, retrospective medical chart review was performed for all patients with spinal cord neurosarcoidosis treated at a single center between 01\/1995 and 12\/2020. Radiological imaging, laboratory test results, the type of immunosuppressive therapy, and function test scores were reviewed. Results: We assessed 39 patients with spinal cord neurosarcoidosis (23 men, 16 women, mean age at presentation 46.4 years, SD 10.2 years). The mean (SD) duration of spinal cord neurosarcoidosis at data abstraction was 9.8 (6.3) years. There were 24 patients (62%) with extensive intramedullary lesions, 8 (21%) with multiple patchy intramedullary lesions, 12 (31%) with leptomeningeal involvement, and 7 (18%) with nerve root enhancement. The cervical spine was the most commonly affected region in 33 patients (85%). The most common presenting symptoms were paresthesia\/neuropathic pain in 20 (51%) and weakness of extremities in 15 (38%) patients. Most patients (n = 37; 95%) had been treated with corticosteroids at symptom onset, and methotrexate was the most used immunosuppressive therapy (n = 19; 49%). Of 34 patients with follow-up magnetic resonance imaging (MRI) available, the median time to improvement per MRI was 10.8 months (95% CI, 6.1\u201317.0 months). Of 31 patients with MRI enhancement at presentation, 18 (58%) had complete enhancement resolution at follow-up, with a median time to resolution of 51.8 months (95% CI, 24.9\u201383.4 months). Patients had significantly lower pyramidal (p = 0.004) and sensory functional (p = 0.031) systems scores from presentation to the last clinic visit. Conclusions: Because spinal cord neurosarcoidosis is challenging to diagnose and no set treatment guidelines exist, clarifying patients\u2019 clinical parameters and responses to various treatments is needed to improve timely and efficient care. The incidence of spinal cord involvement in sarcoidosis in our cohort was higher than intracranial involvement and most patients had a long extensive intramedullary lesion. We also observed that most patients with spinal cord neurosarcoidosis improved clinically and radiologically after treatment; however, the resolution of MRI enhancement after immunosuppressive therapy may take years. Prospective studies of neurosarcoidosis will be crucial to address questions about effective treatment and long-term prognosis.<\/jats:p>","DOI":"10.3390\/jcm13175069","type":"journal-article","created":{"date-parts":[[2024,8,27]],"date-time":"2024-08-27T03:51:06Z","timestamp":1724730666000},"page":"5069","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["A Comprehensive Characterization of Patients with Spinal Cord Neurosarcoidosis: A Single Center Cross-Sectional Study of Clinical Outcomes"],"prefix":"10.3390","volume":"13","author":[{"given":"Rami","family":"Al-Hader","sequence":"first","affiliation":[{"name":"Department of Neurology, Henry Ford Health, Detroit, MI 48202, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9333-8742","authenticated-orcid":false,"given":"Justin","family":"Nofar","sequence":"additional","affiliation":[{"name":"Department of Neurology, Henry Ford Health, Detroit, MI 48202, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-3917-9888","authenticated-orcid":false,"given":"Ahmed","family":"Mohamedelkhair","sequence":"additional","affiliation":[{"name":"Department of Neurology, Henry Ford Health, Detroit, MI 48202, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad","family":"Affan","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Minnesota, Minneapolis, MN 55455, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lonni R.","family":"Schultz","sequence":"additional","affiliation":[{"name":"Department of Neurology, Henry Ford Health, Detroit, MI 48202, USA"},{"name":"Department of Public Health Sciences, Henry Ford Health, Detroit, MI 48202, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8884-6315","authenticated-orcid":false,"given":"Mirela","family":"Cerghet","sequence":"additional","affiliation":[{"name":"Department of Neurology, Henry Ford Health, Detroit, MI 48202, USA"},{"name":"School of Medicine, Wayne State University, Detroit, MI 48201, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,8,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1093\/oxfordjournals.aje.a009096","article-title":"Racial differences in sarcoidosis incidence: A 5-year study in a health maintenance organization","volume":"145","author":"Rybicki","year":"1997","journal-title":"Am. J. Epidemiol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2153","DOI":"10.1056\/NEJMra071714","article-title":"Review Article Medical Progress Sarcoidosis","volume":"357","author":"Iannuzzi","year":"2007","journal-title":"N. Engl. J. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1016\/j.semarthrit.2004.07.011","article-title":"Clinical and magnetic resonance imaging manifestations of neurosarcoidosis","volume":"34","author":"Spencer","year":"2005","journal-title":"Semin. Arthritis Rheum."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1001\/archneur.64.5.691","article-title":"Aggressive therapy for neurosarcoidosis: Long-term follow-up of 48 treated patients","volume":"64","author":"Scott","year":"2007","journal-title":"Arch. Neurol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1093\/qjmed\/hcp042","article-title":"Presentations and outcomes of neurosarcoidosis: A study of 54 cases","volume":"102","author":"Pawate","year":"2009","journal-title":"QJM"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1093\/qjmed\/92.2.103","article-title":"Central nervous system sarcoidosis-diagnosis and management","volume":"92","author":"Zajicek","year":"1999","journal-title":"QJM"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1097\/NRL.0b013e31819bcf84","article-title":"Cerebrospinal fluid angiotensin-converting enzyme for diagnosis of central nervous system sarcoidosis","volume":"15","author":"Khoury","year":"2009","journal-title":"Neurologist"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1546","DOI":"10.1001\/jamaneurol.2018.2295","article-title":"Definition and Consensus Diagnostic Criteria for Neurosarcoidosis: From the Neurosarcoidosis Consortium Consensus Group","volume":"75","author":"Stern","year":"2018","journal-title":"JAMA Neurol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e1084","DOI":"10.1212\/NXI.0000000000001084","article-title":"Neurosarcoidosis: Pathophysiology, Diagnosis, and Treatment","volume":"8","author":"Bradshaw","year":"2021","journal-title":"Neurol. Neuroimmunol. Neuroinflamm."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"117073","DOI":"10.1016\/j.jns.2020.117073","article-title":"The effect of race on clinical presentation and outcomes in neurosarcoidosis","volume":"417","author":"Affan","year":"2020","journal-title":"J. Neurol. Sci."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Kurtzke (2020). Expanded Disability Status Scale (EDSS). A Compendium of Tests, Scales and Questionnaires, Psychology Press.","DOI":"10.4324\/9781003076391-169"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"604","DOI":"10.1161\/01.STR.19.5.604","article-title":"Interobserver agreement for the assessment of handicap in stroke patients","volume":"19","author":"Koudstaal","year":"1988","journal-title":"Stroke"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e722","DOI":"10.1212\/NXI.0000000000000722","article-title":"Clinical and MRI phenotypes of sarcoidosis-associated myelopathy","volume":"7","author":"Murphy","year":"2020","journal-title":"Neurol. Neuroimmunol. Neuroinflamm."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1097\/MAJ.0b013e3182808781","article-title":"Spinal cord neurosarcoidosis","volume":"347","author":"Sohn","year":"2014","journal-title":"Am. J. Med. Sci."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2163","DOI":"10.1007\/s00415-011-6080-3","article-title":"Clinical features of spinal cord sarcoidosis: Analysis of 17 neurosarcoidosis patients","volume":"258","author":"Sakushima","year":"2011","journal-title":"J. Neurol."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Kalantar Motamedi, M.H. (2011). Spinal cord sarcoidosis accompanied with compressive cervical myelopathy. Sarcoidosis Diagnosis and Management, Intech Open.","DOI":"10.5772\/909"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"105","DOI":"10.3174\/ajnr.A7724","article-title":"Spinal cord sarcoidosis occuring at sites od spondylotic stenosis, mimicking spondylotic myelopathy: A case series and review of the literature","volume":"43","author":"Kurtz","year":"2023","journal-title":"AJNR Am. Neuroradiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.jneuroim.2015.05.020","article-title":"Cerebrospinal fluid angiotensin-converting enzyme for diagnosis of neurosarcoidosis","volume":"285","author":"Bridel","year":"2015","journal-title":"J. Neuroimmunol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1336","DOI":"10.1001\/jamaneurol.2017.2492","article-title":"association of prognostic factors and immunosuppressive treatment with long-term outcomes in neurosarcoidosis","volume":"74","author":"Joubert","year":"2017","journal-title":"JAMA Neurol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2517","DOI":"10.1212\/WNL.0000000000003431","article-title":"Treatment of neurosarcoidosis: A comparative study of methotrexate and mycophenolate mofetil","volume":"87","author":"Bitoun","year":"2016","journal-title":"Neurology"},{"key":"ref_21","first-page":"891","article-title":"Long-term outcomes of refractory neurosarcoidosis treated with infliximab","volume":"265","author":"Bouvry","year":"2017","journal-title":"J. Neurol."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Sambon, P., Sellimi, A., Kozyreff, A., Gheysens, O., Pothen, L., Yildiz, H., and van Pesch, V. (2022). Epidemiology, clinical presentation, treatment, and outcome of neurosarcoidosis: A mono-centric retrospective study and literature review. Front. Neurol., 13.","DOI":"10.3389\/fneur.2022.970168"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/17\/5069\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T15:43:17Z","timestamp":1760110997000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/17\/5069"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8,27]]},"references-count":22,"journal-issue":{"issue":"17","published-online":{"date-parts":[[2024,9]]}},"alternative-id":["jcm13175069"],"URL":"https:\/\/doi.org\/10.3390\/jcm13175069","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,8,27]]}}}