title: Intramedullary spinal cord metastasis of lung adenocarcinoma presenting as Brown-Sequard syndrome.
abstract: BACKGROUND
  It is extremely rare for cancer to present first as an intramedullary spinal cord metastasis. Furthermore, because it is unlikely for spinal cord neoplasm to present acutely, an acute presentation may signify metastatic disease and should be considered in the initial differential diagnosis.
  
  
  METHODS
  The authors present a case of a 59-year-old man presenting with Brown-Sequard syndrome and in whom metastatic lung adenocarcinoma to the spinal cord was subsequently discovered. Review of the literature reveals this case to be one of only a very few where intramedullary tumor was the first manifestation of metastatic disease.
  
  
  RESULTS
  The mainstay of treatment for intramedullary spinal metastases remains steroids, radiation, and chemotherapy, though no well-designed study compares these modalities by long-term survival and functional results. This patient underwent local radiation and systemic chemotherapy following surgical resection.
  
  
  CONCLUSIONS
  This patient had no preoperative signs suggesting disease in other organs, making the diagnosis of lung adenocarcinoma metastatic to the intramedullary cord surprising, especially given the extremely rare incidence of spinal intramedullary metastatic disease. However, the patient had an acute presentation, uncommon for primary neoplasm, which may be an indication of metastatic disease.
authors.affiliation: Divisions of Neurosurgery, University of California, San Diego Medical Center, San Diego, California 93103-8893, USA.
authors.forename: Henry E
authors.initials: HE
authors.lastname: Aryan
authors.forename: Azadeh
authors.initials: A
authors.lastname: Farin
authors.forename: Peter
authors.initials: P
authors.lastname: Nakaji
authors.forename: Steven G
authors.initials: SG
authors.lastname: Imbesi
authors.forename: Bret B
authors.initials: BB
authors.lastname: Abshire
mesh_terms: D000230:Adenocarcinoma / Q000556:secondary* / Q000601:surgery; D018437:Brown-Sequard Syndrome / Q000175:diagnosis*; D003937:Diagnosis, Differential; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods; D011184:Postoperative Period; D013120:Spinal Cord Neoplasms / Q000556:secondary* / Q000601:surgery