The Trident Sign on Isolated Sarcoidosis-Associated Myelopathy: A Case Report

This report presents a rare case of a possible isolated sarcoidosis-associated myelopathy (SAM) in a 50-year-old woman who exhibited sensory disturbances and gait instability. Cerebrospinal fluid (CSF) analysis revealed inflammatory characteristics without evidence of infectious disease. Computed tomography (CT) scans of the head, chest, abdomen, and pelvis showed no vascular, neoplastic, or systemic granulomatous abnormalities. Magnetic resonance imaging (MRI) of the spine with gadolinium enhancement demonstrated the characteristic trident sign on axial sequences, strongly suggestive of SAM. The patient underwent pulse therapy with methylprednisolone followed by a tapering course of glucocorticoids, resulting in gradual clinical improvement. Although a definitive diagnosis requires histopathological confirmation, this case underscores the importance of MRI recognition patterns in facilitating prompt diagnosis and guiding effective therapeutic management.