Acta Scientific Neurology (ASNE) (ISSN: 2582-1121)

Editorial Volume 3 Issue 2

The Trident Sign in Inflammatory Myelopathy: A Useful Imaging Tip for the Diagnosis of Neurosarcoidosis

Herbert Alejandro Manosalva Alzate*

Neurologist - National University of Colombia, Fellowship in Stroke Neurology, Movement Disorders and Neurogenetics - University of Alberta and Toronto, Canada

*Corresponding Author: Herbert Alejandro Manosalva Alzate, Neurologist – National University of Colombia, Fellowship in Stroke Neurology, Movement Disorders and Neurogenetics - University of Alberta and Toronto, Canada.

Received: December 27, 2019; Published: January 01, 2020

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  Longitudinally extensive transverse myelitis (LETM) typically involving more than 3 vertebral body levels, offers a challenging differential diagnosis, including entities such as Neuromyelitis Optica Spectrum disorder (NMOSD), neurosarcoidosis, malignancy, metabolic disorders, infectious etiologies, vascular causes such as arteriovenous fistula, post radiation therapy, etc [1]. It is not infrequent to find in the clinical scenario of inflammatory myelopathies, the therapeutic challenge of whether a patient should go on immunosuppressive or immunomodulatory therapy targeting NMOSD versus other entities including granulomatous diseases, from which sarcoidosis appears to be an important key player in the landscape of clinical diagnosis and therapeutic decisions [2]. The clinical presentation of the spinal cord syndrome in neurosarcoidosis may be the one of a transverse myelitis, or of a central spinal cord syndrome which predominantly involves the upper limbs classically following a “cape sensory” distribution with weakness of the upper extremities [3].

  Enhanced MRI of the spine may show besides features of LETM, linear dorsal subpial and central canal spinal cord enhancement giving the characteristic picture of a Trident. This imaging finding is characteristic for spinal cord sarcoidosis [4] (Figure 1). Frequently CT chest may show enlarged hilar or mediastinal lymphadenopathy. Biopsy of the adenopathy is required to confirm the diagnosis of sarcoidosis. Histopathology frequently shows presence of epithelioid histiocytes characteristic for the granulomatous inflammation. The granulomas typically have minimal amount of focal necrosis [5].

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Citation

Citation: Herbert Alejandro Manosalva Alzate. “The Trident Sign in Inflammatory Myelopathy: A Useful Imaging Tip for the Diagnosis of Neurosarcoidosis". Relationship Between Both Values”.Acta Scientific Neurology 3.2 (2020): 01-02.



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