A 69-year-old male presented to the emergency department complaining of a 15-day history of progressive weakness in the right lower limb without apparent cause.
He also had paresthesia in distal areas of both feet.
He did not report back pain and the condition began after a knee pain.
There was no history of interest except for well controlled and treated hypertension.
On examination by the emergency physician, a "stepage" gait and a 4/5 decrease in strength for the dorsal flexion of the right foot were observed.
The patient was diagnosed in the emergency room with a possible neuropraxia of the right external popliteal sciatic nerve. She was referred to a rehabilitation service where, two months after the onset of the symptoms, an intramedullary spinal cord lesion cm was observed.
As a first diagnosis, the possibility of an astrocytoma of medullary cone was reported.
No mass was mentioned except for the one described above and no other process was evident on MRI.
The patient was admitted to the neurosurgery service presenting hypoesthesia in fingertips of both feet, together with a decrease in distal strength of 2/5 in the right lower limb and 3/5 in the left lower limb.
On admission, sphincter control was conserved and the Karnofsky index was 70.
Chest X-ray was reported as normal.
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The patient was operated on performing an osteoplastic laminotomy and a total resection of a mass of l x l cm, easily resectable and little hemorrhagic.
The histological study showed the presence of a metastasis of clear cell carcinoma of probable renal origin.
This diagnosis was confirmed by performing an abdominal CT scan in which a giant renal mass (11 x l 0x 14 cm) and various abdominal and pulmonary metastases of less than 1 cm in size were observed.
The patient had almost total paraparesis during his stay in the neurosurgery service.
The control MRI study performed at 3 months showed no signs of recurrence.
The patient was successfully managed without neurological symptoms.
