Clinical features and natural history of intramedullary spinal cord metastasis

Abstract

Five cases of intramedullary spinal cord metastasis are presented and an additional 50 cases from the English language literature since 1960 are reviewed. Lung cancer and breast cancer were the most frequently occurring primary neoplasms, but a wide variety of solid tumors may cause intramedullary spinal cord metastasis. The presenting symptoms were pain and/or weakness. The neurologic status deteriorated rapidly in the majority of patients in a period to days to weeks. Progression to a cord hemisection syndrome or cord transection occurred in approximately half of the patients. The characteristic myelographic appearance of fusiform swelling of the cord was seen in one third of the patients, but the myelogram was normal in 42%. Plain radiographs of the spine showed no evidence of metastatic disease in three fourths of cases. The cerebrospinal fluid protein level was frequently elevated, but results of cytologic studies were usually negative. High-resolution computer-assisted tomographic scanning may show intramedullary metastases. Radiation therapy combined with corticosteroid administration offers the only effective palliation. The recognition of intramedullary spinal cord metastasis is an ominous finding. Intramedullary spinal cord metastasis generally occurred in the setting of widespread systemic and intracranial disease, but occasionally was the only site of relapse. More than 80% of patients died within 3 months. Heightened awareness of this entity may lead to early diagnosis at a stage when neurologic deficits are reversible and, it is hoped, more effective palliation can be achieved.

A case of long-term survival after multimodal local treatments of intramedullary spinal cord metastasis of squamous cell lung cancer

“…Surgical treatment of spinal intradural carcinoma metastasis may improve survival (5,6), and radiotherapy may contribute to improving survival (3,7,8). We performed multimodal local therapies because our patient had a good performance status and local recurrence with the risk of brain stem compression.…”

Metástase intramedular de carcinoma da tireóide: relato de caso

“…O quadro clínico é dependente do nível da lesão na medula espinhal, podendo ocorrer dor localizada ou de distribuição radicular, déficit motor e sensitivo, disfunção vesical e esfincteriana e síndrome de Bro w n -S é q u a rd , sendo a fraqueza muscular o sintoma mais freq ü e n t e 4 , 1 6 , 1 7 . Em 75% dos pacientes investigados o int e rvalo entre o aparecimento dos sintomas neuro l ó-gicos e o desenvolvimento do déficit neuro l ó g i c o completo é inferior a 1 mês 18,19 .…”

Meningeal Carcinomatosis: A Rare Cause of Cauda Equina Syndrome

“…Hematogenous spread can occur through an arterial route 2 or through the vertebral venous plexus with retrograde spread to the spinal cord. 1,7 Another route is by meningeal carcinomatosis, with tumor cells infiltrating the Virchow-Robin spaces of the vessels going to the spinal cord. 1,7 A third mechanism is direct invasion from contiguous structures through direct extension from the extradural space or CSF, or by means of nerve roots through the dura into the spinal cord.…”

“…1,7 Another route is by meningeal carcinomatosis, with tumor cells infiltrating the Virchow-Robin spaces of the vessels going to the spinal cord. 1,7 A third mechanism is direct invasion from contiguous structures through direct extension from the extradural space or CSF, or by means of nerve roots through the dura into the spinal cord. 5 Interestingly, metastasis is not distributed evenly along the spinal cord.…”

“…The sensitivity of a single CSF examination is approximately 60%. 11 This increases to 75% with two examinations, to 85% with three examinations, 7 and to about 95% after multiple taps. 8 It is therefore advisable to repeat the test when there is a high index of suspicion and the first taps are negative.…”