title: Solitary intramedullary spinal cord tumor presenting as the initial manifestation of metastatic renal cell carcinoma: case report.
abstract: METHODS
  We present the case of a patient with a solitary neoplasm of the intramedullary spinal cord.
  
  
  OBJECTIVE
  The tumor caused findings of Brown-Séquard syndrome and was the initial presentation of widely metastatic renal cell carcinoma (RCC).
  
  
  BACKGROUND
  Metastasis of the intramedullary spinal cord has been uncommonly reported and is extremely rare as the initial sign of a disseminated carcinoma.
  
  
  METHODS
  The tumor was resected, and the patient's neurologic deficits slowly improved. The histopathology suggested an epithelioid neoplasm. However, despite expert review, the diagnosis was nonspecific, and the tumor appeared benign.
  
  
  RESULTS
  It soon recurred in the spinal cord, and repeat imaging studies showed numerous new metastases and a primary renal neoplasm. Biopsy and a repeat histopathologic analysis confirmed RCC, and the patient died of disseminated disease within another 2 months.
  
  
  CONCLUSIONS
  Despite being uncommon, spinal cord metastases should be considered in some patients before surgery because it may expedite diagnosis, mitigate the need for surgery, and improve the quality of life for these patients. Clinical factors suggesting metastasis include a personal or family history of malignancy or conditions predisposing to it, the presence of multiple tumors in the spinal cord or elsewhere, nonspecific constitutional symptoms, such as weight loss or decreased appetite, and, specifically for RCC, an abnormally increased hematocrit.
authors.affiliation: Neurosurgery Service, Department of Surgery, Tripler Army Medical Center, Honolulu, HI 96859-5000, USA. donovand001@hawaii.rr.com
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Donovan
authors.forename: Judy H
authors.initials: JH
authors.lastname: Freeman
mesh_terms: D000328:Adult; D018437:Brown-Sequard Syndrome / Q000209:etiology*; D002292:Carcinoma, Renal Cell / Q000175:diagnosis / Q000556:secondary* / Q000601:surgery; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000175:diagnosis / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D013120:Spinal Cord Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000556:secondary* / Q000601:surgery; D014057:Tomography, X-Ray Computed