Open AccessA case of indirect cauda equina syndrome from metastatic prostate cancer
Author(s) -
Shilo Lefresne,
Alysa Fairchild,
A. Bistritz,
Peter Venner,
Don Yee
Publication year - 2013
Publication title -
canadian urological association journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.477
H-Index - 38
eISSN - 1920-1214
pISSN - 1911-6470
DOI - 10.5489/cuaj.1137
Subject(s) - medicine , cauda equina , cauda equina syndrome , urinary retention , magnetic resonance imaging , constipation , spinal cord compression , spinal cord , prostate cancer , surgery , radiology , urinary incontinence , cancer , psychiatry
We report the case of a patient with metastatic hormone refractoryprostate cancer in whom “indirect” cauda equina syndromedeveloped concurrent with multilevel spinal cord compression(SCC). Three months after his first positive bone scan, a 65-yearoldotherwise healthy man presented with severe back pain, bilaterallower extremity paresthesias, leg weakness and urinary retention.Magnetic resonance imaging (MRI) showed a dural-basedmass causing SCC at the T9, T10 and T11 vertebrae, with a normalcauda equina. He received corticosteroids and palliativeexternal beam radiotherapy, resulting in good pain control andgradual improvement in his neurological symptoms. He did wellfor 8 months, at which time his residual bilateral leg weaknessabruptly worsened and he experienced numbness, paresthesias,urinary incontinence and constipation. Repeat MRI showed progressionof epidural metastatic disease compressing the spinalcord or thecal sac at 7 thoracic vertebral levels. The cauda equinawas also distorted and flattened without evidence of direct solidtumour impingement. We hypothesized that the etiology wasincreased intrathecal pressure due to disrupted cerebrospinalfluid flow resulting from multiple levels of upstream thecal saccompression. It is essential to image the entire spinal cord andcauda equina when patients with metastatic bone disease presentwith neurological symptoms to institute correct treatment andpreserve function and mobility.