Combined intramedullary and intradural extramedullary spinal metastases in malignant melanoma

A patient in their 30s presented with a 3-day history of lower back pain, lower limb weakness and new onset of urinary incontinence. The patient had a history of metastatic melanoma, including to brain, for which they had previously been treated with adjuvant chemotherapy and radiotherapy. Clinical exam revealed a palpable bladder at the umbilicus and reduced power in the lower limbs bilaterally. An MRI whole spine with gadolinium contrast agent revealed multiple enhancing lesions at the T5/6, T9 and T12–L3 levels, pronounced spinal cord oedema and a markedly distended bladder (figures 1 and 2). The location of these lesions within the spinal canal …