Dados do Trabalho

Título

MEDULAR COMPRESSION SYNDROME OF METASTATIC ORIGIN

RESUMO

CES, male, 62 years old, painter, smoker, alcoholic, previously functional and independent. He reported low back pain for a month. Paresthesia in the lower limbs that evolved a day after to symmetrical paraplegia associated with significant change in sensitivity and urinary retention. Admitted to neurology already with deficit. Neurological examination showed paraplegia, urinary and fecal retention, bilateral biceps, patellar and achilles hyperreflexia. Tromner and Hoffman present bilaterally. Abdominal skin reflex absent. Plantar cutaneous reflex in extension on the left limb. Apalesthesia, thermal, tactile and painful anesthesia with a T6 level.
Magnetic resonance imaging of the brain, cervical and thoracic spine were performed, which showed foci of signal alteration in the facets and right pedicle of C3, vertebral bodies of C6 and C7, with a secondary neoplastic aspect.Multiple lesions diffusely distributed in the thoracic vertebrae, especially long expansive and infiltrative lesions involving the vertebral bodies and posterior elements from T4 to T8, with an important soft tissue component at the T5-T6 level. T5-T6 decompressive laminectomy was performed with biopsy of the surgical resection and malignant epithelial neoplasia with clear cell components was visualized. An abdominal tomography was also performed, which showed a suspicious-looking lesion for primary urothelial neoplasm in the right ureter. An investigation was also performed for prostate and lung cancer, both negative. Informed consent was obtained from the patient for a case report.
Spinal cord compression syndrome is a condition that can be caused by different etiologies that cause spinal canal stenosis. It may be the initial manifestation of 20% of metastatic neoplasms. The characteristic manifestations of this syndrome are relatively symmetrical motor deficits, urinary retention or incontinence, loss of sensation, and includes signs of hyperreflexia.
Some tumors tend to metastasize to specific regions of the spine. Renal, gastrointestinal or prostate tumors generate metastases to the lower regions of the thoracic spine and lumbosacral spine. The patient in question had a spinal cord compression syndrome, mainly in the thoracic region, with a primary site in the urinary system.

Palavras Chave

neoplasm, metastasis, paraplegia.