A Case of Spinal Subpial Enhancement
Teaching NeuroImages
Neurology®
Resident & Fellow Section
© 2020 American Academy of Neurology
Vignette
French et al.
• A 56-year-old woman with a history of remote T11 traumatic spinal
transection and residual paraplegia presented with subacute left arm pain, weakness, and sensory loss.
• CSF studies were unremarkable. There were no oligoclonal bands.
Extensive immunological and infectious evaluation was likewise unrevealing.
• The MRI cervical spine showed C4-7 patchy T2 signal and an eccentric enhancing focus with pial involvement (Figure 1). MRI Brain was normal.
• Asymptomatic hilar lymphadenopathy was seen on CT chest.
• Noncaseating granulomas were shown on lymph node biopsy.
© 2020 American Academy of Neurology
Image
© 2020 American Academy of Neurology French et al.
Figure 1
Figure 2
A Case of Spinal Subpial Enhancement
• The patient was diagnosed with probable neurosarcoidosis.
1• Meningeal or subpial involvement of the spine, particularly with chronic enhancement, should prompt a careful systemic
evaluation for sarcoidosis.
1,2• Extraneural sarcoidosis may be present in 90% of patients.
1• Dorsal, subpial, and central canal enhancement, known as the
“trident sign,” may also be helpful diagnostically.
2© 2020 American Academy of Neurology French et al.
