Artikel
Intramedullary spinal cord metastases as initial presentation of systemic cancer – report of a rare case
Intramedulläre spinale Metastase als initiale Präsentation eines systemischen Krebsleidens – Bericht über einen seltenen Fall
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Autoren
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C. Marquart
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Münster
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J. Schröder
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Münster
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H. Wassmann
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Münster
| Veröffentlicht: | 8. Mai 2006 |
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Gliederung
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Objective: The majority of spinal cord compressions by metastases emerge from the extradural and epidural space. Intramedullary spinal cord metastases (ISCM) are very rare. Only 0.1-0.4% of the cancer patients show signs of ISCM. The intramedullary spinal cord metastases as first manifestation of a systemic cancer is extremely rare with only a few cases reported in the literature.
Methods: We report the rare case of a 74-year-old man who was admitted to our hospital with a rapid progression of a sensory deficit on the left from C3 to S1, a tetraparesis most distinct on the lower right limb and a recent onset of constipation and urinary retention. There was no known history of cancer. After MRI of the neck disclosed a cervical intramedullary mass lesion on C 4/5 level suspicious for a primary glial tumour the patient underwent surgery.
Results: Unsuspected the histological analysis of the lesion after microsurgical excision revealed an intramedullary spinal cord metastases (ISCM) of lung cancer, which was confirmed in the further tumour staging. As intramedullary spinal cord metastases are generally associated with poor survival a palliative radiation of the levels C1-6 was additionally performed. Unfortunately tetraparesis and numbness remained unchanged after surgery and radiation. The patients medical condition worsened and the patient died from the underlying disease 8 month after the initial diagnosis.
Conclusions: The very rare occurrence of intramedullary spinal cord mestastases and the absence of pathognomonic symptoms often lead to a delay until an underlying malignancy is discovered. Although rare, intramedullary spinal cord metastases should be considered as differential diagnosis of a spinal intramedullary lesion.
