Acute monoparesis onset in recent aortic valve replacement: A case report

Vertebral metastases are frequent in patients with cancer. They are much more frequent in higher age groups (> 50 years); the lesions can be asymptomatic despite a setting of widespread metastatic disease and may become symptomatic due to bone pain, pathological compression fractures, or extension into spinal canal with cord compression ensuing neurological symptoms. We report the case of a patient, without known history of malignancy, in which shoulder pain was attributed for few months to sequaela of recent cardiac surgery for ascending aortic aneurysm. She was admitted to our ward because of acute onset of lower limb monoparesis which evolved in several days in paraparesis. Only a dorsal magnetic resonance study revealed the presence of a bulky vertebral lesion at D1-D2 level involving the peri-dural space. Neuro-surgical decompression was performed obtaining specimens for histological analysis, which suggested the presence of metastatic adenocarcinomatous lesions of gastrointestinal origin. A computed tomography study partially supported this hypothesis showing only a thickening of rectal wall, even if endoscopic exploration did not show macroscopic mucosal abnormalities. Surgical and medical therapies did not improve the patient’s clinical course and she died few months later.