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Spinal Cord Sarcoidosis — SCE Neurology MCQ

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HardCNS InfectionsSpinal Cord SarcoidosisSCE Neurology

A 51-year-old has a longitudinally extensive cervical myelopathy. MRI shows dorsal subpial enhancement extending centrally around the canal to form a “trident” pattern. AQP4-IgG and MOG-IgG are negative, and chest radiography is unremarkable. Which investigation is most useful next?

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Correct answer: A — Whole-body FDG PET-CT to find occult disease and a safer biopsy site

Dorsal subpial enhancement extending around the central canal to form the trident sign is a strong clue to spinal sarcoidosis. A normal chest radiograph does not exclude occult systemic involvement. FDG PET-CT can identify metabolically active lymph nodes or organs that provide a safer biopsy target than the spinal cord. Serum ACE is neither sufficiently sensitive nor specific to establish the diagnosis. Spinal biopsy has substantial neurological risk and is avoided when extracranial tissue can be found. Treatment may become urgent, but the question asks for the next investigation that improves diagnostic yield and biopsy safety.

Reference: A practical approach to the diagnosis of spinal cord lesions: https://pn.bmj.com/content/18/3/187