Cervical intramedullary spinal cord metastasis as the initial manifestation of colorectal adenocarcinoma: A case report

Background: Intramedullary spinal cord metastasis (ISCM) is a rare manifestation of systemic malignancy and accounts for up to 8.5% of central nervous system metastases. Colorectal carcinoma is an exceedingly uncommon source, contributing to only ~3% of reported ISCM cases. Case Description: A 36-year-old female presented with the rapid onset of quadriplegia with urinary retention. The magnetic resonance imaging demonstrated an enhancing intramedullary lesion at C4–C5 with extensive cord edema. The patient underwent a C4–C5 laminectomy with microsurgical resection of a friable intramedullary mass. The histopathology confirmed a metastatic moderately differentiated adenocarcinoma of colonic origin. The metastatic work up revealed a large sigmoid colon mass with hepatic metastases. Given her Eastern Cooperative Oncology Group 4 status and persistent quadriplegia, she was managed supportively and died 70 days postoperatively. Conclusion: Cervical ISCM may be the initial presentation of metastatic colorectal cancer. Despite aggressive surgical management, the prognosis remains poor, with minimal neurological recovery and likely a short overall survival dictated by the systemic burden of metastatic disease.