Gait Disturbance and Dysarthria Presenting as the First Manifestation of Recurrent Colorectal Adenocarcinoma

Abstract

Purpose: Approximately 20% of patients with colon cancer have metastatic disease at the time of presentation. It usually spreads to regional lymph nodes, liver, lungs, and peritoneum. Initial signs and symptoms might be referable to any of these areas. A 79-year-old man with past medical history of rectal adenocarcinoma diagnosed in 2006, for which he had lower anterior resection and partial colectomy with subsequent chemotherapy and radiotherapy. He presented with a one-week history of gait disturbance, dizziness, slurred speech, and difficulty with his handwriting. He also reported a recent 30-pound weight loss. Brain CT showed a right-sided heterogeneous cerebellar lesion measuring 2.8 x 2.5 cm that was confirmed with MRI. CT of the chest and abdomen showed a right upper lobe lung mass adjacent to the esophagus measuring 3.2 x 2.4 cm, and simple hepatic cysts. EUS was performed, and FNA of the lung mass confirmed the diagnosis of metastatic colon adenocarcinoma that was immunoreactive for CK20 and CDX2. Subsequently, the patient underwent craniotomy and tumor resection, which confirmed the diagnosis of metastatic colon adenocarcinoma to the cerebellum. Neurological symptoms due to brain metastasis could represent the first manifestation of colon cancer even without liver involvement, despite that the liver is considered the most common site of distal metastasis in colorectal adenocarcinoma and lung cancer being the most common source of brain metastasis.FigureFigure