Abstract
Hepatocellular carcinoma (HCC) is an aggressive tumor that frequently occurs in the setting of chronic liver disease and cirrhosis. Herein, we describe a case where a patient presented with acute onset cauda equina syndrome due to an intradural and extramedullary metastatic tumor bleeding from hepatocellular carcinoma (HCC). The patient had lower back pain that had radiated to the bilateral lower legs for 3 weeks. Then, the patient had experienced an acute onset of bilateral lower leg weakness as well as bladder-urinary dysfunction 2 days before going to the ER. The patient received a laminectomy from the L1 to L4 vertebra, removing the intradural spinal tumor and hematoma. To the best of our knowledge, this is the first reported case of HCC metastasized to the cauda equina with tumor bleeding causing cauda equina syndrome.
Highlights
The majority of cauda equina tumors are primary tumors of glial or nerve sheath origin
A lumbosacral magnetic resonance image (MRI) indicated infiltrative hypointensity in the dural sac from T12 to S1 level. compressing the spinal cord and cauda equinal nerves was noticed on both the T1WI and T2WI, leading to suspicion of an intradural hematoma
Hepatocellular carcinoma (HCC) is an aggressive tumor that frequently occurs in the setting of chronic liver disease and cirrhosis
Summary
The majority of cauda equina tumors are primary tumors of glial or nerve sheath origin. Metastases from outside of the central nervous system in this region are very rare [4]. The symptoms of cauda equina lesions are known to be nonspecific. Lower back pain is the most common symptom, followed by sciatic pain, sensory disturbance, motor weakness, and bladder dysfunction [2, 3]. Only 19 cases, including this case, have been reported in the literature [6]. We describe the case of a solitary metastatic HCC to the cauda equina with tumor bleeding. To the best of our knowledge, this is the first reported case of an extramedullary-intradural spinal metastasis of hepatocellular carcinoma causing cauda equina syndrome
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