A 44-year-old woman had a history of progressive hand numbness and pain. Four years earlier, she experienced a tingling sensation in the medial aspect of her left hand. The tingling had progressed to involve her entire left hand and the fourth and fifth fingers of her right hand. She also complained of electric shocklike pains down the medial aspect of both arms. She noted that when taking hot showers, her symptoms were worse. She had difficulties in writing and holding objects, and could no longer exercise.

The pain came in waves lasting approximately 15 minutes. The pain was worse when she was hugged. She has not experienced any visual changes or double vision, weakness, dysarthria, vertigo, or sphincteric difficulties.

Our patient had a subacute cervical myelopathy. Magnetic resonance imaging (MRI) of the spinal cord showed an intramedullary enhancing mass accompanied by expansile surrounding edema from the C3 to C7 level. A spinal cord tumor was initially suspected by the referring physician. Radiological differential diagnosis included ependymoma, demyelinating disease, multiple sclerosis, metastasis, or transverse myelitis. MRI of the brain showed no intracranial mass, abnormal parenchymal or leptomeningeal enhancement, or other focal abnormalities. The cerebellar tonsils were borderline low. Chest radiograph showed bilateral hilar and right paratracheal lymphadenopathy. Pathological findings of the skin biopsy were consistent with those of sarcoidosis (Fig. 16.1).