Cancer and incontinence

In February, 2006, a 68-year-old man came to our emergency department, because, for 5 days, he had been incontinent of urine and faeces. He also had urinary retention. He had longstanding cardiovascular problems: hypertension, ischaemic heart disease, and atrial fi brillation; he had had a heart attack 16 years before. In 2005, he had been found to have a small-cell carcinoma of the left central bronchus, which had been staged as T3 N2 M0. He had been given chemotherapy and radiotherapy. Respiratory examination gave normal fi ndings; cardiovascular examination showed atrial fi brillation. Arm refl exes were normal, but knee and ankle refl exes were weak on both sides. Sensory examination was normal, except for symmetrical anaesthesia in dermatomes S1–S3 (“saddle anaesthesia”), and pain in both S1 dermatomes. The anal refl ex was very weak; anal sphincter tone was severely decreased. MRI of the lumbar spine showed masses in the conus medullaris, cauda equina, and meninges (fi gure); after contrast was injected, the masses were more clearly visible, and we could see a mass at the level of the 11th thoracic vertebra. Cerebrospinal fl uid contained an abnormally Lancet 2008; 372: 1272