Holo-cord drop metastasis from a glioblastoma-when rarity meets reality.

A 32-year-old male presented to our emergency department following a progressive weakness of both his upper and lower limbs since last 2 weeks. He had been operated for supra-tentorial glioblastoma 3 months back (Fig. 1). His neurological examination revealed the findings of spastic quadriparesis with exaggerated deep tendon reflexes. The magnetic resonance imaging of his spine revealed classic findings suggestive of a holo-cord drop metastasis involving all spinal levels (Fig. 2). The patient and his close relatives opted for a symptomatic management after they were counseled of the bleak prognosis of the disease condition.

Figure 1:

Post-operative T2 weighted invert magnetic resonance image of the brain following removal of a supra-tentorial glioblastoma adjacent to the ventricles (white arrow).

Figure 2:

T2 weighted invert magnetic resonance images of the spine showing evidence of holo-cord drop metastasis involving all levels of the spinal cord (white arrows).

Holo-cord drop metastasis from a supra-tentorial glioblastoma is a rare entity. The reported incidence of lepto-meningeal drop metastasis to the cord is only around 2% [1]. Exfoliation during resection of such lesions that are adjacent to the ventricles helps disseminate them via the cerebrospinal fluid onto the lower thoracic and the lumbo-sacral spine owing to the effect of gravity [1]. They are usually detected after a lag of 14–18 months following the treatment of the primary lesion [2]. Such an entity has a very poor prognosis with a median survival of just 2–4 months following its diagnosis [3]. Management is therefore usually palliative, focusing on pain relief, most commonly via external beam radiotherapy [4].