title: Intramedullary spinal cord metastasis and multiple brain metastases from urothelial carcinoma.
abstract: Intramedullary spinal cord metastases (ISCM) are rare spinal cord neoplasms associated with severe neurological deterioration and poor life expectancy. However, their incidence is expected to increase as a result of advances in diagnostic techniques and longer survival of patients with cancer due to improvements in cancer therapy. Reports on ISCM from primary urothelial carcinoma are virtually non existent. We report a 74-year-old male patient with a significant history of a high-grade urothelial carcinoma who presented with progressive back pain and concomitant weakness, grade 3-4/5 proximally and 0-1/5 distally, and distal hyperesthesia and hyperalgesia, particularly of the left lower limb. MRI revealed a contrast-enhancing intramedullary lesion at Th11/Th12. Laminectomies of Th11/Th12 and lesion resection were performed. Postoperative histopathological examinations confirmed the metastatic nature of the lesion. Subsequently the patient developed multiple brain metastases. Radiation therapy was refused by the patient. We conclude that ISCM are devastating complications of systemic cancer. Early and thorough diagnosis, as well as carefully considered and prompt therapy, is important for minimizing the patient's functional deficit, thus improving quality of life.
authors.affiliation: Department of Neuroanatomy and Molecular Brain Research, Ruhr-University Bochum, Universitätsstraße 150, 44780 Bochum, Germany. amr@abdulazim.de
authors.forename: Amr
authors.initials: A
authors.lastname: Abdulazim
authors.forename: Manuel
authors.initials: M
authors.lastname: Backhaus
authors.forename: Martin Nikolaus
authors.initials: MN
authors.lastname: Stienen
authors.forename: Mustafa
authors.initials: M
authors.lastname: Citak
authors.forename: Benjamin
authors.initials: B
authors.lastname: Brokinkel
authors.forename: Tanja
authors.initials: T
authors.lastname: Kuhlmann
authors.forename: Christoph
authors.initials: C
authors.lastname: Horch
mesh_terms: D000368:Aged; D001932:Brain Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000556:secondary*; D006801:Humans; D008159:Lumbar Vertebrae / Q000473:pathology; D008297:Male; D013120:Spinal Cord Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000556:secondary*; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis* / Q000473:pathology; D014571:Urologic Neoplasms / Q000175:diagnosis / Q000473:pathology