[Spinal leptomeningeal metastasis from cerebral glioblastoma: case report]. / Metástasis leptomeníngeas espinales y glioblastoma multiforme: caso clínico.

INTRODUCTION: Glioblastoma multiforme (GBM) is the most common primary malignant tumor of the central nervous system. Its tendency to infiltrate and recur locally is well known. Spinal leptomeningeal metastasis (SLM) due to a GBM are well documented at autopsy in patients previously diagnosed of GBM, however, systemic dissemination with symptomatic leptomeningeal metastasis is quite rare. Most of the time it is diagnosed late and misdiagnosis is a common problem. CASE REPORT: We present a case of a 65-year-old man with a right temporal GBM treated by surgical resection, radiotherapy and chemotherapy, who is readmitted 10 months later as he developed an ataxic gait. A new cerebral magnetic resonance imaging (MRI) showed multiple cerebellar metastasis. He also reported intense lumbar pain on the new admission, increasing in intensity and that was followed by flaccid paraparesis two weeks later. Multiple spinal metastasis deposits were documented by a contrast enhanced spinal MRI. CONCLUSIONS: SLM need to be suspected in patients with a past history of intracranial GBM, who present with clinical features that can not been explained by the primary lesion. Awareness of this complication might facilitate more rapid diagnosis and treatment. A discussion is made regarding SLM in patients with GBM with reference to the medical literature.

Metástasis leptomeníngeas espinales y glioblastoma multiforme: caso clínico / Spinal leptomeningeal metástasis fromcerebral glioblastoma: case report

Introducción. El glioblastoma multiforme (GBM) es el tumor cerebral primario más frecuente en adultos. Presenta una gran capacidad de invasión y recidiva local. Se han documentado metástasis leptomeníngeas espinales (MLE) en las autopsias de pacientes con GBM; no obstante, la diseminación sistémica con afectación leptomeníngea espinal sintomática es rara, diagnosticándose en muchas ocasiones de forma errónea o tardíamente. Caso clínico. Presentamos el caso de un paciente de 65 años diagnosticado de un GBM temporal derecho, que es tratado quirúrgicamente con radioterapia y quimioterapia adyuvante y que 10 meses después vuelve a ingresar tras desarrollar una alteración de la marcha. Se realizó una nueva resonancia magnética cerebral, objetivándose múltiples metástasis en el cerebelo. Posteriormente el paciente presentó dolor lumbar intenso y 2 semanas después una paraparesia flácida. Se realizó una resonancia magnética espinal en la que aparecieron múltiples depósitos metastásicos. Conclusiones. Las MLE se deben sospechar en todos los pacientes con antecedentes de GBM cerebral que presentan clínica no justificable por la lesión primaria. El conocimiento de esta complicación puede facilitar un diagnóstico y tratamiento más precoz. Realizamos una revisión bibliográfica en relación con las MLE en los pacientes con GBM (AU)

Introduction: Glioblastoma multiforme (GBM) is the most common primary malignant tumor of the central nervous system. Its tendency to infiltrate and recur locally is well known. Spinal leptomeningeal metastasis (SLM) due to a GBM are well documented at autopsy in patients previously diagnosed of GBM, however, systemic dissemination with symptomatic leptomeningeal metastasis is quite rare. Most of the time it is diagnosed late and misdiagnosis is a common problem. Case report: We present a case of a 65-year-old man with a right temporal GBM treated by surgical resection, radiotherapy and chemotherapy, who is readmitted 10 months later as he developed an ataxic gait. A new cerebral magnetic resonance imaging (MRI) showed multiple cerebellar metastasis. He also reported intense lumbar pain on the new admission, increasing in intensity and that was followed by flaccid paraparesis two weeks later. Multiple spinal metastasis deposits were documented by a contrast enhanced spinal MRI. Conclusions: SLM need to be suspected in patients with a past history of intracranial GBM, who present with clinical features that can not been explained by the primary lesion. Awareness of this complication might facilitate more rapid diagnosis and treatment. A discussion is made regarding SLM in patients with GBM with reference to the medical literatura (AU)

Tratamiento endovascular del síndrome del robo de la subclavia sintomático / Endovascular treatment of symptomatic subclavian steal syndrome

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