Abstract
Dural prostate metastases (DPM) are a rare manifestation of metastatic prostate cancer seen in approximately one to six percent of cases. Presenting symptoms may include signs of elevated intracranial pressure, headache, altered mental status, or cranial nerve palsies. Hearing loss, sensory changes, dysarthria, and dysphagia are rare symptoms in DPM that were present in our patient. We present a case of a 58-year-old male with a known diagnosis of adenocarcinoma of the prostate presenting with symptoms of acute exacerbation of chronic obstructive pulmonary disease (COPD), sub-acute right-sided hearing loss, and right-sided facial paralysis. Over the course of hospitalization, his neurological symptoms worsened and he developed dysarthria, dysphagia, facial numbness, and worsening back pain. He also appeared more withdrawn and lethargic. The symptoms prompted a neurological evaluation and a magnetic resonance imaging (MRI) revealed multiple areas of bone marrow signal abnormality compatible with osseous metastatic disease. There was extensive smooth dural thickening as well as focal nodular thickening, both consistent with dural metastases. The patient was treated with corticosteroids and external beam radiation therapy (EBRT) with improvement in his back pain and facial paralysis. He died two weeks after completing EBRT. Although rare, DPM should be suspected in males over 50 years of age presenting with neurological symptoms. An MRI with gadolinium is most helpful in delineating the presence and extent of dural and calvarial involvement. Corticosteroids and EBRT have been shown to improve neurological function in up to 67% of patients. However, median survival post-radiation remains approximately three months.
Highlights
Prostate cancer is a leading cause of mortality in men
Sensory changes, dysarthria, and dysphagia are rare symptoms in Dural prostate metastases (DPM) that were present in our patient
We present a case of a 58-year-old male with a known diagnosis of adenocarcinoma of the prostate presenting with symptoms of acute exacerbation of chronic obstructive pulmonary disease (COPD), sub-acute right-sided hearing loss, and right-sided facial paralysis
Summary
Prostate cancer is a leading cause of mortality in men. prostate cancer metastases to bone and retro-peritoneal and pelvic lymph nodes are common, intracranial, dural prostate metastases (DPM) are a rare manifestation of the disease [1]. Over the course of hospitalization, his respiratory symptoms improved but he developed dysphagia, facial numbness, worsening right-sided hearing loss, and back pain. He had developed dysarthria and appeared withdrawn and lethargic. In view of his symptoms, an MRI brain was done that revealed multiple areas of bone marrow signal abnormality compatible with osseous metastatic disease. Given the patient’s back pain, an MRI of the spine was done that revealed T1/T2 hypointense lesions within vertebrae T12, L5, the sacrum and the right iliac bone suggesting sclerotic osseous metastases. A repeat CT scan revealed no changes from before His radiation therapy was continued during the hospitalization and he was discharged to the rehabilitation facility. It was reported that he died at the nursing home two weeks after completion of radiation therapy
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