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Our objective was to delineate clinical features and treatment outcome of patients with intramedullary spinal cord metastasis(ISCM).There are no reports of a large experience with this rare cancer complication.We reviewed records retrospectively from 1980 to 1993 to identify patients with histologically confirmed systemic cancer,clinical features of myelopathy and either tissue-proven ISCM or abnormal neuroimaging findings consistent with ISCM.We identified 40 patients who fulfilled these criteria.In nine,ISCM was the initial presentation of cancer.Nineteen patients had lung primaries(small cell in 12).Twenty-one patients had pain,35 had demonstrable sensory loss,37 had weakness,and 25 had urinary incontinence at presentation.Nine patients had true Brown-Sequard syndrome and nine others had pseudo-Brown-Sequard syndrome.Median duration of symptoms at diagnosis was 28 days(range 3 days to 18 months).Thirteen patients had prior brain metastasis,nine had brain metastasis simultaneous with ISCM and one had brain metastasis after ISCM;11 had concomitant leptomeningeal metastases.Spinal magnetic resonance findings were abnormal in 30/30 patients,myelographic results were abnormal in 16/20 and eight had pathologic confirmation of ISCM.Thirty-five patients had radiotherapy and five had surgery;four were untreated or treated elsewhere.Median survival was 4 months for patients receiving radiotherapy and 2 months for patients not receiving radiotherapy.Eleven patients survived>six months. Twenty-three were ambulatory at ISCM diagnosis and 21 were ambulatory at latest followup.We conclude that ISCM as the initial presentation of malignancy is not rare and hemicord syndromes occur frequently.Although long term survival is poor,treatment preserves ambulation in most patients still ambulatory at diagnosis.Focal radiotherapy is indicated in most patients. |
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Brown Sequard syndrome
carcinoma of lung
life expectancy
MRI
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MRI,spinal cord
neoplasm,metastatic to CNS
neoplasm,metastatic to CNS-survival
neoplasm,metastatic to CNS-treatment of
pain
prognosis
radiation therapy,CNS treatment and complications with
review article
spinal cord
spinal cord,metastasis to
spinal cord,metastasis to,prognosis of
spinal cord,metastasis to,treatment of
spinal cord,neoplasm,intramedullary
treatment of neurologic disorder
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