Non-compressive oncological myelopathy
Myelopathy in malignant tumors often cause spinal cord compression. But if cannot locate the cerebrospinal fluid block with additional diagnostic tools on spinal cord MRI or CT scan, then, later, is just as difficult to differentiate intramedullary metastases, paracarcinomatous myelopathy and radiation myelopathy.
In case of metastases in a patient with progressive myelopathy without symptoms of spinal cord compression during diagnostic procedures (myelography, CT or MRI), the most probable is metastasis within the spinal cord parenchyma (intramedullary metastasis). Paraneoplastic myelopathy in patients occurs less often. Patient complaints of backache may be the first (but not necessarily) symptom of tumor metastasis into the spinal cord parenchyma (intramedullary metastasis). In this type of metastases location in a patient may occurs increasing spastic paraparesis or paresthesia.
Intradural intramedullary tumor is located in the spinal cord center.
Dissociated loss or complete preservation of sensitivity in the sacral segments is characteristic of the spinal cord internal compression. Such condition in patients are rare. More often detects asymmetrical paraparesis and partial sensitivity loss.
When diagnosing a patient with myelography, CT or MRI, will be visible spinal cord is swelling without evidence of its external compression. In half of the patients spinal cord studies on CT and myelography may be visible normal morphological pattern. Therefore, spinal MRI, as a diagnostic method, is most informative in differentiating metastatic lesions from the primary tumor within the spinal cord parenchyma (intramedullary tumors).
Tumor metastases into the spinal cord parenchyma (intramedullary metastases) usually originate from bronchogenic carcinoma, rarely from cancer, breast cancer and other solid tumors. Metastases of melanoma is rarely cause spinal cord external compression. Metastases of melanoma is more common in the form of a tumor within the spinal cord parenchyma (intramedullary mass process). Metastasis of melanoma is a single eccentrically located node, getting into the spinal cord through the bloodstream. Radiation therapy of spinal cord melanoma metastasis can be effective.
Meningitis because of carcinoma - a common form of CNS lesions in oncology. Carcinomatous meningitis does not cause of myelopathy, unless there is proliferation and infiltration under the soft spinal arachnoid with the adjacent nerve roots. Otherwise, it leads to the formation of nodules and secondary spinal cord infiltration or compression.
Incomplete, not accompanied by pain syndrome, cauda equina lesions may be due to nerve roots carcinomatous infiltration. Patients with carcinomatous meningitis often complain of headaches. In patients cerebrospinal fluid (CSF) analysis in dynamics will identify cancerous cells, increased protein content, low glucose concentration.
Lumbar puncture is performed at carcinomatous meningitis, it determinate the color, transparency, and the composition of cerebrospinal fluid.
Progressive necrotic myelopathy, which combines the unexpressed inflammation, occurs in solid tumors as the long-term effects of cancer. Myelography and cerebrospinal fluid (CSF) is usually normal, with a slight increase in protein levels. Subacute progressive spastic paraparesis develops in patients within a few days or weeks and generally characterized by asymmetry. Concomitant paresthesia in the distal extremities, extending up to the level of formation of sensory disorders, and later - a pelvic organs functions lesion (bladder dysfunction). With progressive necrotic myelopathy also affected several adjacent spinal cord segments.
The contrast agent is introduced at myelography in the subdural space by lumbar puncture.
Oncological patients’ radiation therapy cause not acute, but progressive myelopathy in further. It is due to hyalinization and vascular occlusion. Radiation myelopathy is often a serious differential diagnostic problem for the neurosurgeon or neurologist, when the spinal cord located at other structures radiation therapy undergoing area (mediastinal lymph nodes, etc.). The difference between radiation myelopathy and paracarcinomatous myelopathy and intramedullary metastasis is difficult, except cases where the patient has a history of its previous radiotherapy.
If you have any questions on the diagnosis or treatment of non-compressive oncological myelopathy, you can ask them to our neurosurgeon or neurologist: (499) 130–08–09
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