Abstract
We herein report the case of a 51-year-old male presenting with progressive neurological symptoms, including numbness, tingling below the umbilicus, urinary difficulty, constipation, and weakness. Following a recent coronavirus disease 2019 (COVID-19) vaccination, magnetic resonance imaging (MRI) revealed longitudinally extensive transverse myelitis (LETM) with a trident-shaped pattern on axial sequences, a hallmark of spinal neurosarcoidosis. Positron emission tomography-computed tomography demonstrated multiple hypermetabolic hilar and mediastinal lymphadenopathies, further supporting this diagnosis, particularly given the possibility of false-positive aquaporin-4-immunoglobulin G (AQP4-IgG) enzyme-linked immunosorbent assay (ELISA) results. Early recognition of the trident sign enabled the prompt initiation of corticosteroids and immunosuppressive therapy, highlighting the diagnostic utility of this specific MRI pattern in an appropriate clinical scenario, with primary spinal cord lymphoma as a differential diagnosis.
Publication Date
4-1-2025
Content Type
Article
PubMed ID:
Citation
Khalil, A., Abrams, K. J., Duarte, M. L., & Freitas, L. F. (2025). Pointing the trident in the right direction: recognizing spinal neurosarcoidosis through a specific MRI pattern. Arquivos de neuro-psiquiatria, 83(4), 1–2. https://doi.org/10.1055/s-0045-1807720
Comments
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