Asunto(s)
Lipomatosis/complicaciones , Lipomatosis/patología , Mieloma Múltiple/complicaciones , Mieloma Múltiple/patología , Enfermedades de la Columna Vertebral/complicaciones , Enfermedades de la Columna Vertebral/patología , Corticoesteroides/farmacología , Antineoplásicos/farmacología , Dexametasona/farmacología , Progresión de la Enfermedad , Humanos , Lenalidomida , Lipomatosis/tratamiento farmacológico , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Mieloma Múltiple/tratamiento farmacológico , Médula Espinal/patología , Enfermedades de la Columna Vertebral/tratamiento farmacológico , Talidomida/análogos & derivados , Talidomida/farmacología , Resultado del TratamientoRESUMEN
BACKGROUND: We present a case of spinal leptomeningeal metastasis from an intracranial glioblastoma multiforme that presented with radicular pain. CASE DESCRIPTION: A 55-year-old man with a previously treated supratentorial glioblastoma multiforme presented with a 12-month history of thoracic radicular pain. MRI of the thoracic spine demonstrated an intradural extramedullary metastatic tumor deposit at the levels of T8-T10. External beam radiotherapy to the thoracic spine provided a minimal decrease in the intensity of the radicular pain. The lack of appreciation of the metastatic potential of the primary intracranial tumor resulted in delayed diagnosis and treatment. CONCLUSION: Spinal leptomeningeal metastasis needs to be suspected in patients with a past history of intracranial glioblastoma multiforme, who present with the clinical features of radiculopathy or myelopathy. Awareness of this condition will facilitate appropriate intervention.
Asunto(s)
Glioblastoma/secundario , Neoplasias Meníngeas/secundario , Radiculopatía/etiología , Neoplasias de la Médula Espinal/secundario , Neoplasias Supratentoriales/diagnóstico , Diagnóstico Diferencial , Glioblastoma/diagnóstico , Glioblastoma/patología , Glioblastoma/radioterapia , Humanos , Imagen por Resonancia Magnética , Masculino , Neoplasias Meníngeas/diagnóstico , Neoplasias Meníngeas/patología , Neoplasias Meníngeas/radioterapia , Persona de Mediana Edad , Radiculopatía/patología , Radiculopatía/radioterapia , Médula Espinal/patología , Neoplasias de la Médula Espinal/diagnóstico , Neoplasias de la Médula Espinal/patología , Neoplasias de la Médula Espinal/radioterapia , Neoplasias Supratentoriales/patología , Neoplasias Supratentoriales/radioterapia , Lóbulo Temporal/patologíaRESUMEN
We present a case of spontaneous haemorrhage into an empty sella turcica with the features of subclinical pituitary apoplexy. A 66-year-old woman with a previously resected pituitary adenoma presented four months later with progressive headache and visual deterioration. Cranial MRI demonstrated hyperacute blood products in a recurrent pituitary adenoma. Operative findings were of subacute blood in an empty sella turcica. There was no operative or subsequent histological evidence of tumour recurrence. The intrasellar haemorrhage was evacuated via a trans-sphenoidal approach, resulting in a rapid improvement in visual function. Endocrine deficits required thyroxine, corticosteroid and desmopressin supplementation. Haemorrhage into an empty sella turcica has not been previously described and needs to be suspected as a clinical entity in patients presenting with the features of pituitary apoplexy. Awareness of this clinical condition will prevent preoperative misdiagnosis.