Neurosarcoidosis presenting as an anterior horn syndrome

We report a 43 year old man who developed progressive weakness of all extremities with fasciculation over four months. Neurological examination was consistent with an anterior horn syndrome. CSF examination showed elevated opening pressure and a lymphocytic pleocytosis. The diagnosis of sarcoidosis was confirmed by muscle and lacrimal gland biopsies. He was treated with the combination of corticosteroids and intravenous immunoglobulin with almost complete resolution of his symptoms a few weeks after discharge. We hypothesize that meningeal granulomatous inflammation compressed the exiting anterior roots which resulted in motor dysfunction with preservation of peripheral sensory fibers.