Combined intramedullary and intradural extramedullary spinal metastases in malignant melanoma

Description

A patient in their 30s presented with a 3-day history of lower back pain, lower limb weakness and new onset of urinary incontinence. The patient had a history of metastatic melanoma, including to brain, for which they had previously been treated with adjuvant chemotherapy and radiotherapy. Clinical exam revealed a palpable bladder at the umbilicus and reduced power in the lower limbs bilaterally.

An MRI whole spine with gadolinium contrast agent revealed multiple enhancing lesions at the T5/6, T9 and T12–L3 levels, pronounced spinal cord oedema and a markedly distended bladder (figures 1 and 2). The location of these lesions within the spinal canal was mixed, including intramedullary metastases (ie, within the substance of the spinal cord) and intradural extramedullary metastases (ie, in the subarachnoid space but extrinsic to the cord). Lesions obliterated the cauda equina resulting in a cauda equina syndrome.

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