Intramedullary metastasis - lung cancer
Known advanced small cell lung cancer with worsening bilateral leg weakness and urinary incontinence. She has confirmed brain metastases.
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Large intradural intramedullary lesion central within the conus medullaris with intense post-contrast enhancement. The lesion is mostly isointense in T1w and T2w, and hyperintense on STIR. Displacement and compression of the nerve roots can be seen on T2w axial images. There is also enhancement of the cauda equina and distal cord compatible with leptomeningeal spread.
Intramedullary spinal cord tumors are predominantly primary, like astrocytoma or ependymoma, but on rare occasions metastastic lesions can be present. In patients with known primary malignancy and progressive deterioration of neurological symptoms, we should always suspect spinal intramedullary metastasis.