Intramedullary spinal cord metastasis as a first manifestation of a renal cell carcinoma: report of a case and review of the literature

The authors report the case of a 70-yeal-old woman who developed a Brown-Se quard-syndrome within 6 weeks caused by an intramedullary spinal cord metas tasis of an occult renal cell carcinoma. Intramedullary metastases are rare and represent only 4-8.5% of central nervous system metastases. An importa nt feature of intramedullary metastases is the rapid progression of neurolo gical deficits which necessitates rapid treatment. There are only eight ear lier reports of intramedullary metastasis due to renal cell carcinoma. (Sch iff D, O'Neill BP. Intramedullary spinal cord metastases: clinical Features and treatment outcome. Neurology 1996;47:906 12; Belz P. Ein Fall von intr amedullaerer Grawitz-Metastase im Lumbalmark. Frankfurt Z Pathol 1912;10:43 1 44; Gaylor JB, Howie JW. Brown Sequard-syndrome. A case of unusual aetiol ogy. J Neurol Neurosurg Psychiatry 1938;1:301 5; Kawakami Y, Mair WGP. Haem atomyelia due to secondary renal carcinoma. Acta Neuro Pathol 1973;26:85-92 ; Strang RR. Metastatic turner of the cervical spinal cord. Med J Aust 1962 ;1:205-6; Von Pfungen. Uber einige Falle von Haematomyclic nichttraumatisch en Ursprungs. Wien Klin Rdsch 1906;20:13-50; Weitzner S. Coexistent intrame dullary metastasis and syringomyclia of cervical spinal cord. Report of 3 c ase. Neurology 1960;674-8). To the best of our knowledge this is the first report on a patient in whom symptoms from the metastasis of a renal cell ca rcinoma preceded the detection of the primary tumor. This report presents t he clinical, neuroradiological and histopathological findings of an intrame dullary metastasis of a 1 renal cell carcinoma and provides an overview of the literature on intramedullary spinal cord metastases. (C) 2000 Elsevier Science B.V. All rights reserved.