Cauda equina syndrome due to leptomeningeal carcinomatosis: a medical dilemma

Firouzabadi, Leila Izadi; Mead, Paul; Berry, J W; Hanif, Sheharyar

doi:10.1136/bcr-2019-232297

Cited by 1 publication

(2 citation statements)

References 3 publications

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“…However, as these symptoms may also occur in other benign or malignant conditions, including intervertebral disc herniation or vertebral fracture, patients' history of oncological disease and systemic metastases should be investigated to plan appropriate metastatic diagnostic protocols (71,72). The occurrence of cauda equina syndrome has also been largely reported across our included studies (51,(54)(55)(56). This likely owes to the fact that CSF circulation is slower in the cauda equina and the basilar cisterns, which represent the two regions mostly affected by leptomeningeal seeding (66, 67).…”

Section: Discussionmentioning

confidence: 92%

“…As concurrent diffuse multifocal intracranial LMs have been documented in more than half of our pooled cases, we emphasize the importance to include brain axis imaging in known metastatic patients with suspected spine lesions or in patients with newly diagnosed spine LMs (11,65). CSF cytologic analysis may be used to confirm the diagnosis of LMs by detecting pathological cellular lines similar to the primary tumors' ones (38,46,54,57,59). However, lumbar taps may be difficult to obtain, especially in patients with CSF obstruction, and negative CSF cytology may occur in up to 40% of patients with clinical and radiological diagnosis of LMs (6,65,69,73).…”

Section: Discussionmentioning

confidence: 99%

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Leptomeningeal Metastases of the Spine: A Systematic Review

et al. 2022

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Background/Aim: Leptomeningeal metastases (LMs) of the spine have complex management. We reviewed the literature on spine LMs. Materials and Methods: PubMed, EMBASE, Scopus, Web-of-Science, and Cochrane were searched following the PRISMA guidelines to include studies of spine LMs. Results: We included 46 studies comprising 72 patients. The most frequent primary tumors were lung (19.4%) and breast cancers (19.4%). Median time from primary tumors was 12 months (range=0-252 months). Cauda equina syndrome occurred in 34 patients (48.6%). Nodular spine LMs (63.6%) were more frequent. Concurrent intracranial LMs were present in 27 cases (50.9%). Cerebrospinal fluid cytology was positive in 31 cases (63.6%). Cases were managed using palliative steroids (73.6%) with locoregional radiotherapy (55.6%) chemotherapy (47.2%), or decompressive laminectomy (8.3%). Post-treatment symptom improvement (32%) and favorable radiological response (28.3%) were not different based on treatment (p=0.966; p=0.727). Median overallsurvival was 3 months (range=0.3-60 months), not significantly different between radiotherapy and chemotherapy (p=0.217). Conclusion: Spine LMs have poor prognoses. Radiotherapy, chemotherapy, and surgery are only palliative, as described for intracranial LMs.Leptomeningeal metastases (LMs) are late-stage complications of systemic malignancies, occurring approximately in 5-10% of patients with solid and hematologic neoplasms (1, 2). Frequently manifesting with new neurological deficits, LMs may be detected at T1-contrast MRI follow-ups as nodular or diffuse meningeal enhancement, and may be confirmed with high-volume cerebrospinal fluid (CSF) taps for cytology (3,4). Several systemic therapeutic options are available, but the treatment goal remains palliation, as mean survival ranges 3-6 months (3,5,6).LMs involving the spine represent unique entities that may severely impact patients' functional status (7, 8). While diffuse spinal LMs may remain clinically silent and go undetected, nodular spinal LMs frequently compress spinal nerve roots causing radicular pain or neurological impairments (2, 9). Nodular spinal LMs may also lead to acute or progressive cauda equina syndrome, which require urgent diagnosis and management (10,11). While surgical decompression may provide prompt symptomatic relief, patients may not be good candidates due to their significant tumor burden (2, 3). In these cases, locoregional radiation, chemotherapy, and other systemic treatments may be pursued to achieve similar clinical outcomes (12, 13).Although spinal LMs pose significant challenges in the oncological care of patients with systemic metastases, only 619 This article is freely accessible online.

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