A case of indirect cauda equina syndrome from metastatic prostate cancer

Lefresne, Shilo; Fairchild, Alysa; Bistritz, A.; Venner, Peter; Yee, Don

doi:10.5489/cuaj.1137

Cited by 4 publications

(3 citation statements)

References 23 publications

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“…17 We theorize that cancer cells can subsequently seed within CSF, providing an alternate explanation for CNS metastases. Lefresne et al 38 reported a case of dura-based metastases at the T-4 and L4-5 levels with foraminal extension. Although the L4-5 metastasis was discovered later, we wonder if this case could be explained by perineural spread and subsequent intradural seeding, only with the L4-5 tumor lesion being somewhat salvaged and delayed by previous radiotherapy.…”

Section: Perineural Spread Beyond the Lumbosacral Plexusmentioning

confidence: 99%

Perineural spread of pelvic malignancies to the lumbosacral plexus and beyond: clinical and imaging patterns

Capek

Howe

Amrami

et al. 2015

FOC

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OBJECT Perineural spread along pelvic autonomie nerves has emerged as a logical, anatomical explanation for selected cases of neoplastic lumbosacral plexopathy (LSP) in patients with prostate, bladder, rectal, and cervical cancer. The authors wondered whether common radiological and clinical patterns shared by various types of pelvic cancer exist. METHODS The authors retrospectively reviewed their institutional series of 17 cases concluded as perineural tumor spread. All available history, physical examination, electrodiagnostic studies, biopsy data and imaging studies, evidence of other metastatic disease, and follow-up were recorded in detail. The series was divided into 2 groups: cases with neoplastic lumbosacral plexopathy confirmed by biopsy (Group A) and cases included based on imaging characteristics despite the lack of biopsy or negative biopsy results (Group B). RESULTS Group A comprised 10 patients (mean age 69 years); 9 patients were symptomatic and 1 was asymptomatic. The L5–S1 spinal nerves and sciatic nerve were most frequently involved. Three patients had intradural extension. Seven patients were alive at last follow-up. Group B consisted of 7 patients (mean age 64 years); 4 patients were symptomatic, 2 were asymptomatic, and 1 had only imaging available. The L5–S1 spinal nerves and the sciatic nerve were most frequently involved. No patients had intradural extension. Four patients were alive at last follow-up. CONCLUSIONS The authors provide a unifying theory to explain lumbosacral plexopathy in select cases of various pelvic neoplasms. The tumor cells can use splanchnic nerves as conduits and spread from the end organ to the lumbosacral plexus. Tumor can continue to spread along osseous and muscle nerve branches, resulting in muscle and bone “metastases.” Radiological studies show a reproducible, although nonspecific pattern, and the same applies to clinical presentation.

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Section: Perineural Spread Beyond the Lumbosacral Plexusmentioning

confidence: 99%

Perineural spread of pelvic malignancies to the lumbosacral plexus and beyond: clinical and imaging patterns

Capek

Howe

Amrami

et al. 2015

FOC

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“…It had to be suitable for completion in a 6-week period, incorporate a literature review, and preferably be suitable for publication. 4 , 5 …”

Section: Ipe Program Descriptionmentioning

confidence: 99%

Initiation of a multidisciplinary summer studentship in palliative and supportive care in oncology

Fairchild¹,

Watanabe²,

Chambers³

et al. 2012

JMDH

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PurposeThe optimal setting for interprofessional education (IPE) for prelicensure health care trainees is unclear, especially in a field as complex and emotionally challenging as oncology. In this article, the authors describe the initiation of the Cross Cancer Institute Multidisciplinary Summer Studentship in Palliative and Supportive Care in Oncology, a 6-week, multidisciplinary team-based clinical placement in supportive care, designed to incorporate features of best practice cooperative learning.MethodsA steering committee established goals, structure, eligibility criteria, application process, funding, and a consensus approach to instruction and evaluation for the IPE program. Studentship components included mandatory and flexible clinical time, an exploratory investigation, discussion groups, and a presentation. Two senior students per iteration were selected from clinical nutrition, medicine, nursing, occupational therapy, pharmacy, physiotherapy, respiratory therapy, social work, and speech–language pathology applicants. These students completed questionnaires investigating their views of their own and others’ professions at baseline, at the end of the rotation, and 6 months after the studentship.ResultsEight students from medicine, clinical nutrition, occupational therapy, physiotherapy, and speech–language pathology have participated to date. At the elective’s end, students have described a more positive view of multidisciplinary team practice, with each participating discipline perceived as both more caring and more subservient than at baseline. In general, changes in attitudes were maintained 6 months after completion of the placement.ConclusionThis 6-week multidisciplinary placement is feasible, successful, and potentially transferable to other academic settings. The results of this study suggest that even over as short a period as 6 weeks, objective attitudinal and perceptual change is seen.

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“…It was hypothesized to result in cauda equina flattening in a patient who had metastatic spinal lesions well above the cauda equina. 2 In a case series, 5 patients with ankylosing spondylitis who developed chronic arachnoiditis and dural fibrosis resulting in dural sac dilations had significant improvement of their pain, urinary function, and sensation after lumboperitoneal shunts. 3 Our patient experienced severe back pain presumably due in part to elevated spinal CSF pressure.…”

Section: Discussionmentioning

confidence: 99%