Metastatic cord compression Flashcards
1
Q
Metastatic cord compression definition
A
- malignancy causing compression of the spinal cord or cauda equina
- caused by compression of vertebral body
- common in lung, prostate, breast, myeloma
2
Q
Cord compression presentation
A
- unrelenting back pain (cervical or thoracic or progressive lumbar)
- nocturnal pain
- spinal pain exacerbated by straining
- motor weakness (above L1 - UMN in legs and sensory changes; below L1 - LMN in legs and perianal numbness)
3
Q
Cord compression differentials
A
- radiculopathy - sciatica
- vertebral disc prolapse
- general back pain
- chemo-induced myopathy
4
Q
Cord compression red flags
A
- bilateral leg weakness
- saddle anaesthesia
- loss of continence
5
Q
Cord compression investigations
A
- bedside:
- observations
- DRE
- lower limb neuro exam
- imaging:
- MRI asap, within 24h
6
Q
Cord compression management
A
- dexamethasone 8mg BD
- urgent local radiotherapy within 24h
- surgical decompression if fit + good prognosis
