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Query: UMLS:C0027627 (metastases)
 103,950 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Clinical interest in spinal compression and resultant paraplegia due to metastases has mounted in recent years. This has stimulated attention to the neuropathology of the condition. Fourteen cases of spinal cord compression due to vertebral metastases are compared with over 100 traumatic cases. In the traumatic lesions there is central haemorrhagic necrosis leading to cavitation and gliosis with nerve root regeneration in the late stages. In the metastatic cases, lesions are often peripheral, pie-shaped and are related to vascular factors. The neuropathology of cord necrosis due to metastatic spinal disease is therefore different to trauma. These observations have clinical importance in planning treatment.
Paraplegia 1983 Feb
PMID:Vertebral metastases and spinal cord compression. 683 91

Clinicopathologic findings are reported in the case of an unusual combined degeneration of the cerebellum and spinal cord associated with bronchial carcinoma. Clinical features were sudden sensory onset, rapid and complete flaccid paraplegia with ascending course, sphincter paralysis, rapid impairment of general condition, and high protein content in CSF without inflammatory cell reaction. The neuropathologic findings included massive transverse necrosis at the thoracic level and degeneration of the ascending and descending tracts. The necrotic areas involved mostly white matter without any vascular topography. There was no inflammation or specific vascular alteration. In the cerebellum widespread cortical atrophy was observed. There were no metastases in the cord, meninges, vertebral column, or nerve roots. The simultaneous occurrence of two distinct types of nervous tissue alterations reflects the pathomechanisms effective in CNS reactions to extraneuronal malignancy.
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PMID:Combined acute necrotic myelopathy (ANM) and cerebellar degeneration associated with malignant disease. 685 2

Three clinico-pathological cases of necrotic myelopathies with a distant malignancy are presented. Two cases had a lymphosarcoma and one case a prostatic carcinoma. They were compared to 13 well studied other cases collected in the literature. These myelopathies were related to solid visceral tumours in 8 cases and to lymphomas in 5 cases. The disease could be individualized on clinical grounds (flaccid paraplegia with bladder and bowell incontinence and sensory loss without clear-cut upper boundary developing over a few weeks with normal CSF and fast impairement of general condition), and, on pathological features. It is characterized by one or several spinal cord necrosis areas, often asymetrical, involving mostly white matter, without any vascular topography. Axons are involved as well as myelin sheats. There is mild inflammation and no specific vascular alteration. There is no metastases in the cord, meninges, vertebral column or nerve root. No vascular occlusion is found. The mechanism of the disease is unknown. The frequent occurence of lymphomas could suggest the presence of immunopathological factors.
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PMID:[Necrotic myelopathies and neoplastic pathologie. Three clinico-pathological cases (author's transl)]. 689 68

Spinal cord compression is a rare but serious complication of malignant diseases in children. Epidural cord compression was noted in 81 patients within the past 17 years at this center. The complication developed at different times during the course of the primary disease. For 29 of our patients, cord dysfunction was one of the initial signs of cancer--Ewing sarcoma, neuroblastoma, Hodgkin disease, and malignant lymphoma. By contrast, for most of the patients with osteosarcoma and rhabdomyosarcoma, it appeared later in their clinical course. The treatment outcome of patients who were paraplegia with complete loss of sensory function for greater than or equal to 48 hours was poor. Only four of 22 in this group became ambulatory. Ten patients with osteosarcoma did not undergo laminectomies because they all had multiple metastases and terminal disease. Paraplegia developed in all ten. There was no difference in ambulatory rates among other patients, with or without laminectomies.
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PMID:Metastatic epidural tumors in children. 695 58

A review of 10 years experience with prostatic carcinoma was undertaken with a search for neurologic complications. An unusual case presenting with symptoms of hemiplegia is reviewed. Of 154 charts, 90 provided adequate clinical information for complete analysis. Nineteen cases with neurologic complications were found and were restricted entirely to advanced (stages C and D) disease. Thirty-seven percent of patients with advanced disease developed neurologic complications. The most frequent complaints were related to organic brain syndrome, paraplegia, and radiculopathy. Eight patients developed peripheral nerve or spinal cord injury related to metastatic disease. Five patients suffered metabolic or paraneoplastic complications; three patient's symptoms related to central or epidural metastases and two patients developed neurologic symptoms related to complications of therapy. All neurologic symptoms improved given appropriate diagnosis and treatment. A brief review of the literature is included emphasizing the diverse nature of neurologic complications in this common neoplasm.
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PMID:Neurologic complications in prostatic carcinoma. 732 73

The majority of spinal neoplasms are metastatic lesions. This paper reports results of combination therapy of ninety-one cases of spinal metastasis verified by pathology. Most of them were metastases from breast, lung, thyroid and gastrointestinal cancers. Multiple metastatic lesions were mainly treated by chemotherapy. Radiotherapy was for radio-sensitive solitary lesions. Indication for operation included: (1) isolated spinal focus with unknown site of primary tumor; (2) recurrence or aggravation of tumor after chemotherapy or radiotherapy; (3) isolated radioresistant focus; and (4) the patients having paraplegia or an instable spine. Thirty cases were mainly treated by chemotherapy, 10 by radiotherapy, and 51 by operation. After the combination therapy, 13 cases were completely free of symptoms, 44 alleviated and 11 invalid. Of the 39 cases having paraplegia, 3 had complete recovery, 15 partial recovery and 21 no improvement. Of 85 cases having been followed up for 1-4 years, 51 cases (59.3%) survived for 3-11 months, 25 (29.1%) for 1-2 years and 10 (11.6%) for 2-3 years. The average survival time was 10.5 months. Analyzing the clinical and radiographic manifestations of the tumors and their treatment and prognosis, we consider that early diagnosis and combination therapy are the major factors influencing the therapeutic effect of spinal metastatic tumors.
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PMID:[Combination therapy of 91 cases of spinal metastases]. 817 68

Spinal metastases are a common complication of cancer that should be managed quickly and aggressively. Most often from lung or breast cancer (or due to lymphoma), they usually seed from blood into vertebrae and extend into the epidural space. The most common presentation is pain and weakness, and the evolution can be rapid with paraplegia within days. Better prognosis is related to slower onset and pretreatment motor status, so spinal metastases are an emergency. Testing includes X-rays, neuroimaging, myelogram/CT and most recently MRI. Treatment is guided by the severity of neurological deficits, whether compression is by soft tissue or bone, and the presence of instability. A soft tissue mass with only mild to moderate deficits can be treated with radiation. Surgery is required for severely affected patients who are deteriorating rapidly with instability and bone in the canal. New approaches and fusion techniques facilitate decompression and stabilization.
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PMID:Spinal epidural metastases: a common problem for the primary care physician. 819 40

Of 35 patients with prostate carcinoma and suspected spinal cord compression 26 (74%) had myelograms and/or magnetic resonance imaging studies demonstrating epidural spinal cord compression. In 5 of 26 patients (19%) spinal cord compression was the first indication of prostate cancer. All patients were initially treated with radiation, steroids and androgen deprivation therapy. Three patients underwent laminectomy. Of 12 patients (100%) ambulatory at presentation 12 remained ambulatory. Of 12 patients (83%) who were paraparetic at presentation 10 were ambulatory after treatment. However, 2 of these patients subsequently had recurrent compression and became paraplegic. Overall, 7 of 26 patients (27%) had recurrent compression. Of 5 patients who either presented with paraplegia or in whom paraplegia developed secondary to recurrent spinal cord compression 4 remained paraplegic despite treatment. The average survival of these 5 patients after treatment was 3.9 months versus 18 months for the group as a whole. In ambulatory or paraparetic patients radiation, androgen deprivation therapy and steroids are effective palliative therapy. However, patients who present with paraplegia or in whom paraplegia developed secondary to recurrent compression are often not palliated by this combination therapy. Prophylactic radiation of vertebral metastases discovered concurrently with compressive metastases may be valuable in preventing paraplegia.
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PMID:Spinal cord compression secondary to prostate carcinoma: treatment and prognosis. 842 13

50 patients with metastatic disease of the spine underwent dorsal decompression and stabilization with the Cotrel-Dubousset-Instrumentation from 1987 to 1991. Indications for surgical treatment were neurologic deficit, spinal instability, and/or pain resistant to medical or radiation treatment. No external orthotics were used postoperatively. Pain was relieved dramatically in 45 patients. Among 25 patients suffering from neurologic deficit preoperatively, 13 improved, 15 remained unchanged, whereas 2 developed an incomplete, transient paraplegia. 15 (7) patients were alive after 1 (2) years. Postoperative complications were frequent, but there were only 2 failures of the stabilization device requiring reoperation.
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PMID:Decompression/stabilization of the metastatic spine. Cotrel-Dubousset-Instrumentation in 50 patients. 845 41

We report a 24-year-old man who presented unilateral multiple cranial nerve involvements followed by progressive paraplegia. The patient expired after developing DIC and pneumonia. Post-mortem examination revealed Ewing's sarcoma originated in the pubic bone with extensive metastases including the clivus which was responsible for his cranial nerve lesions. The patient was well until 24 years of age when he noted an onset of pain and a mass in the pubic region. The histology of the biopsy specimen of the tumor suggested Ewing's sarcoma. He was treated with chemotherapy and local radiation. A year after, he noted an onset of nuchal pain, difficulty in tongue movement, dysarthria, deafness in the left ear, and diplopia. On admission to our hospital in July 1990, neurological examination revealed an alert and intelligent Japanese male in no acute distress. The olfactory to the trigeminal nerves appeared intact. He showed complete abducens nerve palsy, facial weakness, mild deafness, and weakness of the soft palate, the sternocleidomastoid muscle and the tongue, all on the left side. The remainder of the neurological examination was unremarkable except for dysesthesia along the left C8 and Th1 dermatoms. Radiological examination revealed a 10 x 10 cm sclerotic mass in the public bone and a high signal mass lesion between the clivus and the pons in the T2-weighted MRI. His clinical course was complicated by acute paraplegia with anesthesia below the Th4 dermatom, DIC, and respiratory distress due to plural effusion. Post-mortem examination revealed a necrotic and hemorrhagic tumor in the pubic bone. The histology was consistent with Ewing's sarcoma.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[A 24-year-old man presenting Garcin syndrome and paraplegia]. 847 71


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