A case of indirect cauda equina syndrome from metastatic prostate cancer
AbstractWe report the case of a patient with metastatic hormone refractory
prostate cancer in whom “indirect” cauda equina syndrome
developed concurrent with multilevel spinal cord compression
(SCC). Three months after his first positive bone scan, a 65-yearold
otherwise healthy man presented with severe back pain, bilateral
lower extremity paresthesias, leg weakness and urinary retention.
Magnetic resonance imaging (MRI) showed a dural-based
mass causing SCC at the T9, T10 and T11 vertebrae, with a normal
cauda equina. He received corticosteroids and palliative
external beam radiotherapy, resulting in good pain control and
gradual improvement in his neurological symptoms. He did well
for 8 months, at which time his residual bilateral leg weakness
abruptly worsened and he experienced numbness, paresthesias,
urinary incontinence and constipation. Repeat MRI showed progression
of epidural metastatic disease compressing the spinal
cord or thecal sac at 7 thoracic vertebral levels. The cauda equina
was also distorted and flattened without evidence of direct solid
tumour impingement. We hypothesized that the etiology was
increased intrathecal pressure due to disrupted cerebrospinal
fluid flow resulting from multiple levels of upstream thecal sac
compression. It is essential to image the entire spinal cord and
cauda equina when patients with metastatic bone disease present
with neurological symptoms to institute correct treatment and
preserve function and mobility.
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