Key Clinical Message
MESCC may cause sensory and motor symptoms to appear first in the distal
legs due to the specific lamination of the corticospinal and
spinothalamic tracts (lower extremity fibers, most superficial and upper
extremity fibers, the deepest).
An 84-year-old man experienced right-sided bundle-like chest pain 5 days
before admission. Three days after the incident, he had symmetric
ascending weakness and sensory loss in the distal legs. Neurological
examination revealed the same conditions below the Th8 level. He had
been receiving leuprorelin acetate and bicalutamide for prostate cancer.
He exhibited exaggerated and Babinski reflexes in the legs. Spinal
magnetic resonance imaging revealed that the epidural tissue process
compressed the medullary cord in the ninth thoracic vertebra (Figure 1
and 2). He underwent posterior thoracic fusion surgery, and the symptoms
immediately improved. Intraoperative pathological findings revealed a
metastatic vertebral tumor, and metastatic epidural spinal cord
compression (MESCC) was diagnosed.
MESCC occurs when cancer metastasizes to vertebrae or epidural space and
causes compresses of spinal cord, which causes paraplegia if
untreated.1 Owing to the specific lamination of the
corticospinal and spinothalamic tracts (lower extremity fibers, most
superficial and upper extremity fibers, the deepest), the thoracic
compressive lesion may cause sensory and motor symptoms to appear first
in the distal legs.