Two cases of lung cancer with leptomeningeal metastasis diagnosed by gadolinium enhanced MRI

Spinal paralysis due to leptomeningeal metastasis is one severe condition of the oncology emergency. In this paper, we reported two lung cancer patients with leptomeningeal metastasis. Both cases complained of back pain or lumbago two months prior to spinal paralysis. Although metastases to the vertebral bone were suspected at onset, bone scintigraphy was negative in both cases. Case 1 followed numbness in left leg and progressed to paralysis of the bilateral lower extremities subacutely. Gadolinium enhanced MRI of the spine showed multiple small nodular enhancing lesions in the spinal canal and these nodules compressed the spinal cord at several spine levels. Radiation (30 Gy) to Th₃-S₂ was performed but the spinal paralysis was not improved. Case 2 presented acute onset of paralysis of the bilateral lower extremities. Gadolinium enhanced MRI of the spine showed large enhancing nodules at Th₂-Th₃ level with marked compression of the spinal cord. Spinal canal around the nodules was dilated by the retention of CSF flow. After the completion of radiation (45 Gy) to the nodule, the nodule diminished and the spinal paralysis improved.