An Unusual Presentation of Adult Tethered Cord Syndrome Associated with Severe Chest and Upper Back Pain

Abstract

Adult tethered cord syndrome (ATCS) is a rare entity that usually presents with multiple neurological symptoms, including lower extremity pain, backache, lower extremity muscle weakness, and bowel/bladder disturbances. Prompt surgical treatment is often necessary to avoid permanent sequelae. We report a 63-year-old man with sudden-onset severe right chest and upper back pain, followed by urinary retention. His initial workup included computed tomography of the abdomen and pelvis, which showed a presacral mass. His symptom-driven neurological workup focused on the cervical and thoracic spine, the results of which were normal. Pelvic radiographs and magnetic resonance imaging of the lumbosacral spine showed spina bifida occulta, meningocele, and presacral masses consistent with a teratomatous tumor. His symptoms, except for urinary retention, improved dramatically with surgical treatment. The excised specimen contained a teratomatous lesion plus an organized hematoma. Hematoma formation was suspected as the trigger of his sudden-onset right chest and upper back pain.

Drop foot and adult onset tethered cord syndrome caused by filum terminal ependymoma: A case report

“…Diagnosing and treating adult TCS is challenging because of its rarity and mimics wide pathologies. 11 Radiological studies often help diagnose TCS based on the position of conus medullaris below L2, fatty and thickened filum terminal (63%). 12 According to this case, symptoms contributing to the diagnosis were low back and leg pain, loss of sense of the entire left leg, and urinary disorder.…”

Atypical Chest Pain: An Unusual Presentation of Spinal Metastasis due to Penile Carcinoma

“…The initial presentation in this case was isolated chest pain as opposed to back pain. Chest pain as a presenting symptom of spinal pathology has been previously reported, however with back pain as a concomitant symptom [ 14 – 16 ]. We believe this to be the first case of isolated chest pain in the presence of spinal metastasis to be reported.…”