Metastases of the spinal cord from remote neoplasms. Study of five cases

Five patients with acute or subacute myelopathy are reported in whom neuroradiologic imaging or open surgery showed an intrinsic spinal cord tumor. Histologic diagnosis was obtained either through direct spinal cord biopsy or after biopsy or removal of a former or concurrent intracranial metastasis. Carcinoma of "possible" gastrointestinal origin, oat-cell carcinoma, melanoma, and bronchogenic adenocarcinoma in two cases were demonstrated. The clinical course showed a devastating and irreversible deterioration of the neurological condition in all patients but one, who exhibited a mildly symptomatic disease. Our uncertainty with cases of intramedullary spinal cord metastasis resulted in a nonstandardized approach to these patients. The role of magnetic resonance imaging, the radiotherapeutic option, and the pertinent literature are briefly discussed.