A case study of paraneoplastic cauda equina syndrome caused by a gastric adenocarcinoma

Anita Hargreaves,David Monk,Debbie Hunt,Shomari Zack-Williams

doi:10.5348/ijcri-201643-cr-10631

Abstract

Introduction: cauda equina syndrome results from dysfunction of multiple sacral and lumbar nerve roots in the lumbar vertebral canal, leading to impairment of bladder, bowel, or sexual function, and perianal or “saddle” numbness. the most common cause of cauda equina syndrome is disc herniation resulting in compression at L4/5 and L5/s1. However, we will discuss the case of cauda equine syndrome with a paraneoplastic cause. there are only a handful of cases in literature of paraneoplastic cauda equine syndrome, and none specifically as a result of gastric adenocarcinoma. Paraneoplastic neurological syndromes (of which paraneoplastic cauda equine syndrome is one) are described as remote effects of cancer on the neurological system. they are rare, affecting less than 1/10,000 patients with cancer. In this case, the cauda equina was the target for an autoimmune response directed against antigens common to both the cancer and the nervous system. case report: A 71-year-old female was admitted with a two-month history of lumbar back pain, radiating down her thigh, progressive weakness of both legs, numbness of the sacral area, urinary incontinence and 6.4 kilogram unintentional weight loss within 2 months. Abdominal radiograph, breast examination, lumbar puncture, and autoantibodies screens

Highlights

Cauda equina syndrome results from dysfunction of multiple sacral and lumbar nerve roots in the lumbar vertebral canal, leading to impairment of bladder, bowel, or sexual function, and perianal or “saddle” numbness
In conclusion, an unusual presentation of acute and progressive neuropathy without obvious spinal/ cranial aetiology and associated cachexia should prompt thorough investigation to exclude a neoplastic process, as paraneoplastic syndromes may be the first sign of malignancy
Cauda equina syndrome is described as dysfunction of multiple sacral and lumbar nerve roots in the lumbar vertebral canal, which can result in a combination of clinical features

Summary

INTRODUCTION

Cauda equina syndrome is described as dysfunction of multiple sacral and lumbar nerve roots in the lumbar vertebral canal, which can result in a combination of clinical features. The final diagnosis given was that of secondary paraneoplastic neuropathy, caused by a gastric adenocarcinoma in the body of the stomach, which, in this case, caused a cauda equina syndrome This specific case has not been reported in literature. Computed tomography, magnetic resonance imaging and isotope bone scanning showed neither evidence of an abnormality of the spine (for example any evidence of spinal metastasis/sufficient disc protrusion to produce the symptoms) or abnormality of the cauda equina itself. This led us to the conclusion that the symptoms were caused by a paraneoplastic phenomenon as all other plausible causes had been excluded

Findings

DISCUSSION

CONCLUSION