Spinal astrocytoma with secondary cerebral metastasis: A case report

Abstract

Intracranial dissemination of spinal tumours is rare, particularly for low-grade lesions such as pilocytic astrocytoma. We report a 65-year-old man who presented with progressive limb weakness, sensory loss and bladder dysfunction. Spinal MRI showed a large intramedullary lesion at C7-T1 with normal brain imaging, and an inflammatory myelitis was initially suspected; corticosteroids were ineffective, and he became wheelchair dependent. Two years later, he developed seizures and reduced consciousness. Brain MRI revealed a new right frontal haemorrhagic mass with oedema and hydrocephalus, while the spinal lesion remained radiologically stable. Biopsy of the intracranial mass confirmed pilocytic astrocytoma (WHO grade I). Despite plans for radiotherapy, he deteriorated and died before treatment. Spinal pilocytic astrocytomas are usually benign and intracranial spread is extremely uncommon. This case, notable for the patient’s age and lack of malignant transformation, highlights the need for brain imaging when new neurological symptoms arise in patients with known spinal astrocytoma.