Use the MRI enhancement pattern and the postoperative context to recognize sarcoidosis-associated myelopathy and avoid confusing it with multiple sclerosis. Document the lesion level and the management step it implies.

The pancake sign is a postoperative MRI flattening pattern after decompression; Sarcoidosis-associated myelopathy often shows long or short segment T2 lesions with gadolinium enhancement; A subpial enhancement pattern is a clue to sarcoidosis; Persistent enhancement helps distinguish sarcoidosis from transient demyelinating disease; Recognizing the imaging pattern guides prognosis and follow-up intensity