Hypokalemic Paraparesis Progressing to Quadriparesis in a Case of Intradural Spinal Tumor

INTRODUCTION: This study aims to present a case of spinal intradural tumor with paraparesis referred for surgery, which later progressed to quadriparesis and subsequently found to have hypokalemia due to primary hyperaldosteronism causing a clinical dilemma. CASE REPORT: A 46-year-old male was referred for surgery from peripheral center with a diagnosis of an intradural tumor at L1. The patient presented to us with paraparesis, which progressed to quadriparesis. On evaluation, the patient was found to have low serum potassium levels of 1.6 mmol/L with hypertension. The plasma aldosterone-renin was elevated which was suggestive of primary hyperaldosteronism. Further, investigations in the form of CT abdomen suggested the presence of a right adrenal adenoma. The patient was diagnosed with hypokalemia-induced quadriparesis and treated conservatively with potassium supplementation and later spironolactone. The patient recovered completely in 72 h and was able to walk independently before discharge. CONCLUSION: Spinal tumor may not always be the cause for patient’s paraparesis; non-spinal factors such as hypokalemia should be kept in mind. The presence of intradural spinal tumor with hypokalemia may cause decision dilemma regarding treatment and interdisciplinary approach is recommended to facilitate the treatment.