Ayşegül SARSILMAZ, Melda APAYDIN, Makbule VARER, Engin ULUÇ, Vermi DEĞERLİ, FUNDA KARBEK AKARCA

Kauda equina-konus sendromuna neden olan dissemine leptomeningeal karsinomatozis

İntradural ekstrameduller metastazlar, leptomeningeal karsinomatozisin alt grubudur ve spinal metastazların yaklaşık %4-6’sını oluşturur. Genellikle intrakranial metastazlardan damla sekonder metastaz olarak karşımıza çıkar ve lomber bölgede kauda equina düzeyinde, sinir kökler boyunca yayılır. Günümüzde, kanser olgularında survinin uzaması nedeniyle, geç komplikasyon olarak daha sık görülmeye başlandışı bildirilmiştir. Bunun yanı- sıra, kauda equina sendromu, ilk tablo olarak gelen ve primer malignite odağı sonradan saptanan olgular da bildirilmektedir. Biz, akciğer adenokarsinomu tanısı almış ve takip edilmekte olan, kauda equina-konus sendromu bulguları ile gelen ve MRG’ sinde, beyin metastazı izlenmedi ği halde, lomber bölgede diffuz leptomeningeal karsinomatosis saptanan olguyu sunduk. Aşrı, alt ekstremitelerde güçsüzlük ve üriner, anal disfonksiyon triadı; kauda equina sendromu (KES) ile gelen olgularda intradural ekstrameduller metastaz, leptomeningeal karsinomatozis akla gelmelidir. MRG tetkiki, bu olgu grubunda erken tanı ve bilinmiyorsa, daha erken primer malignite odağının saptanması açısından önemlidir.

Disseminated leptomeningeal carcinomatosis (lc); presenting with cauda equina-conus syndrome

Intradural extramedullary(intrathecal) metastases; a subtype of leptomeningeal carcinomatosis (LC), constitute approximately 4-6% of spinal metastases. They most commonly represent drop metastases from accompanying intracranial secondary lesions that become entangled within the nerve roots of the cauda equina. Generally, they occur as a late complication. However, there are some cases related to cauda equina syndrome (CES) that are the first presentation of primary malign lesion. We present the case of a patient who presented with symptoms of cauda equina-conus syndrome and for whom subsequent investigations revealed diffuse lumbar intrathecal metastases and locally advanced lung cancer without brain metastases. The case emphasizes the need for thorough investigation in the presence of the triad: back pain, weakness in the lower extremities, and urinary urgency/incontinence. Cauda equina syndrome due to intrathecal metastases should always be considered. Spine MRI with contrast is the most informative investigative study for these patients.

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