Intramedullary spinal cord metastasis from bladder carcinoma: case report

Intramedullary spinal cord metastases are rare complications of systemic cancer. Although the majority of these metastases spread from lung cancer, they have been seen to arise from a variety of other primary sources. The authors report the second known case of an intramedullary spinal cord metastatic lesion arising from primary bladder carcinoma.

A 74-year-old man presented with an 8-day history of rapidly progressive Brown-Séquard syndrome, with weakness in his left lower extremity and decreased pain and temperature sensation in his right lower extremity. The patient's history was significant for high-grade urothelial carcinoma that had been treated 6 months earlier with radical cystectomy. A magnetic resonance imaging scan showed an enhancing intramedullary lesion at T1-T2.

The patient underwent laminectomies, and removal of his intramedullary lesion was attempted. Intraoperative pathology revealed that the lesion was metastatic in nature, and the decision was made to perform a subtotal resection. Pathology later confirmed that the lesion was consistent with a less differentiated form of his bladder primary. Postoperatively, the patient experienced minimal improvement in his symptoms, and he was subsequently treated with fractionated external beam radiotherapy. The patient died 7 weeks after undergoing surgery for his spinal cord lesion.

The occurrence of metastatic primary bladder cancer in the intramedullary spinal cord has been reported in the literature only once previously. Despite the lack of similar cases, the acute onset of Brown-Séquard syndrome was highly suggestive of a metastatic lesion. A review of relevant literature is provided.