This case study explores the challenging neurological manifestations in a 59-year-old female diagnosed with large-cell neuroendocrine carcinoma (LCNEC). The patient initially presented with aphasia, which led to the discovery of an intracranial cystic-necrotic metastasis. Despite surgical and aggressive radio-chemotherapy treatments, her condition progressed to extensive leptomeningeal carcinomatosis (LMC) and intradural spinal metastases. This resulted in right dominant paraparesis, saddle hypesthesia, and urinary incontinence, developing into paraplegia even after emergency radiotherapy of the complete spine. The unprecedented extent of LCNEC metastases in both intracranial and intraspinal regions raises important considerations for diagnostic assessment in neuroendocrine tumors with neurological symptoms. Despite aggressive intervention, the prognosis remains poor, emphasizing the challenges in managing advanced LCNEC stages with widespread metastases.
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Mahler et al. (2024) studied this question.