A case study of paraneoplastic cauda equina syndrome caused by a gastric adenocarcinoma

Introduction: Cauda equina syndrome results from dysfunction of multiple sacral and lumbar nerve roots in the lumbar vertebral canal, leading to impairment of bladder, bowel, or sexual function, and perianal or “saddle” numbness. The most common cause of cauda equina syndrome is disc herniation resulting in compression at L4/5 and L5/S1. However, we will discuss the case of cauda equine syndrome with a paraneoplastic cause. There are only a handful of cases in literature of paraneoplastic cauda equine syndrome, and none specifically as a result of gastric adenocarcinoma. Paraneoplastic neurological syndromes (of which paraneoplastic cauda equine syndrome is one) are described as remote effects of cancer on the neurological system. They are rare, affecting less than 1/10,000 patients with cancer. In this case, the cauda equina was the target for an autoimmune response directed against antigens common to both the cancer and the nervous system. Case Report: A 71-year-old female was admitted with a two-month history of lumbar back pain, radiating down her thigh, progressive weakness of both legs, numbness of the sacral area, urinary incontinence and 6.4 kilogram unintentional weight loss within 2 months. Abdominal radiograph, breast examination, lumbar puncture, and autoantibodies screens were all negative. Abdominal and pelvic CT, spinal MRI, radioisotope scan and abdominal USS still did not demonstrate any malignant process. One month after admission, the patient deteriorated with sudden abdominal peritonism, tachycardia and hypothermia. An urgent CT was performed, which demonstrated a gastric perforation. A laparotomy was undertaken which demonstrated a 4-cm gastric perforation. Biopsies were taken and the histology subsequently demonstrated a high grade, poorly differentiated adenocarcinoma. From this diagnosis, it was ascertained that she had been suffering from secondary paraneoplastic neuropathy, caused by the gastric adenocarcinoma in the body of the stomach. This specific case has not been reported in literature within the last 10 years. Conclusion: In conclusion, an unusual presentation of acute and progressive neuropathy without obvious spinal/ cranial aetiology and associated cachexia should prompt thorough investigation to exclude a neoplastic process, as paraneoplastic syndromes may be the first sign of malignancy. (This page in not part of the published article.) International Journal of Case Reports and Images, Vol. 7 No. 4, April 2016. ISSN – [0976-3198] Int J Case Rep Imag 2016;7(4):249–253. www.ijcasereportsandimages.com Hunt et al. 249 CASE REPORT OPEN ACCESS A case study of paraneoplastic cauda equina syndrome caused by a gastric adenocarcinoma Debbie Hunt, Shomari Zack-Williams, Anita Hargreaves, David Monk