Greg Shinaman, MD
Resident
University of Rochester
Rochester, New York, United States
Aubree Fairfull, MD
Assistant Professor of Clinical Physical Medicine & Rehabilitation
University of Rochester Strong Memorial Hospital
Rochester, New York, United States
Sarah Snyder, BS
Medical Student
Lake Erie College of Osteopathic Medicine
Erie, Pennsylvania, United States
Intramedullary spinal cord metastasis secondary to stage IV colon cancer causing T10 complete paraplegia.
63-year-old male with history of stage IV colon cancer and metastases to liver and vertebrae presented with lower limb weakness and multiple falls.
On initial exam, patient was ambulatory and had 4/5 strength in bilateral lower limbs and positive babinski. MRI confirmed an enhancing mass in the thoracic spinal cord associated with edema.
Patient underwent radiation therapy, resulting in worsened functional deficits. Subsequent MRI showed significant progression of spinal cord edema prompting treatment with steroids. Exam at this time showed 0/5 strength in bilateral lower limbs with abnormal sensation below the level of T10.
Patient elected not to undergo surgical treatment and was admitted to inpatient rehabilitation to improve mobility for discharge home.
Unfortunately, his rehabilitation course was complicated by sepsis secondary to Fournier’s Gangrene prompting transfer off the rehabilitation unit for emergent debridement.
Metastatic disease of the spinal cord and spinal column can be defined based on anatomic location as extradural, intradural extramedullary and intradural intramedullary. The incidence of ISCMs is higher than predicted, autopsy studies show their presence in 0.9 – 2.1% of all cancer patients. Most of these cases are asymptomatic.
ISCMs occur in the thoracic spinal cord most commonly. They most often stem from lung cancer followed by breast cancer. Prognosis is poor with a median survival of approximately 3.6 months despite treatment. Patients with multiple ISCMs have significantly decreased survival compared to patients with a single lesion. Treatment for this condition includes chemotherapy and radiation, although surgery can be considered and may confer improved survival, although studies are limited. Presented is a rare case of intramedullary spinal cord metastasis secondary to colon cancer that highlights the utility of acute rehabilitation and also the poor prognosis of this diagnosis.
Conclusions:
