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Cauda equine syndrome as the primary symptom of leptomeningeal metastases from lung cancer: a case report and review of literature

Authors Liu Y, Wang B, Qian Y, Di D, Wang M, Zhang X

Received 11 February 2018

Accepted for publication 31 May 2018

Published 20 August 2018 Volume 2018:11 Pages 5009—5013

DOI https://doi.org/10.2147/OTT.S165299

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Manfred Beleut

Peer reviewer comments 2

Editor who approved publication: Dr Arseniy Yuzhalin


Yang Liu,* Bin Wang,* Yongxiang Qian, Dongmei Di, Min Wang, Xiaoying Zhang

Department of Cardiothoracic Surgery, The Third Affiliated Hospital of Soochow University, Changzhou 213003, China

*These authors contributed equally to this work

Abstract: Cauda equine syndrome (CES) is a neurological condition caused by compression of the cauda equine. Here, we demonstrate a case of CES as the primary symptom of leptomeningeal metastases from non-small cell lung carcinoma without brain metastases. A 59-year-old male suffered progressive lower extremity motor dysfunction, urinary dysfunction, and lower extremity sensory dysfunction. He was clinically diagnosed with CES. Nuclear magnetic resonance imaging demonstrated several vague nodules in the area of conus medullaris and cauda equine, without lumbar or thoracic herniated discs. The serum carcinoembryonic antigen concentration was 191.20 ng/mL. The conclusion following positron emission tomography–computed tomography was a right upper lung malignant tumor with mediastinal lymph node metastasis and cauda equina metastasis. Pathologic diagnosis was of primary adenocarcinoma of the lung by bronchoscopic biopsy. EML4–ALK fusion and EGFR mutations were absent, and thus the patient received chemotherapy. However, symptoms of intracranial hypertension arose 1 month later, and the patient died 3 months postadmission. Emerging CES may be a sign of metastasis of a malignant tumor, presenting an extremely challenging condition, especially for patients with lung cancer. Positron emission tomography–computed tomography is a fairly effective technique to make the diagnosis.

Keywords: cauda equine syndrome, leptomeningeal carcinomatosis, positron emission tomography–computed tomography, lung cancer

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