n_spinalcordcomp
acute spinal cord compression
Acute spinal cord compression:
common tumours:
breast carcinoma
lung carcinoma
NHL & Hodgkin's lymphoma
multiple myeloma
prostate carcinoma
summary:
65% thoracic, 20% lumbosacral spine, 15% cervical
May be first sign of neoplasm/ complicate pre-existing disease
Result from bleeding, infection, fracture
> 95 % long Hx (weeks ⇒ months) of back pain prior to Dx/other symptoms
minimal weakness may ⇒ profound, irreversible weakness over hrs ⇒ rapid Rx
myelopathy symptoms and signs are late findings
symptoms:
continuous, localised back pain, progressive in severity and duration
pain requiring analgesia
+/- radicular (bilateral with thoracic spine) as nerve root compressed
NB: lymphoma deposits may be painless
myelopathy:
signs:
may be subtle/ absent (does not exclude significant SC compression)
localised spinal tenderness on percussion
sensory level
symmetrical weakness + hyporeflexia (very early)
spasticity + hyperreflexia (later)
decreased rectal sphincter tone
abnormal gait
general exam:
investigations:
management:
-
immediate neurosurgical consultation
radiotherapy is definitive treatment for most
surgical laminectomy and decompression if: architectural instability, tissue confirmation required, max. XRT given, tumor radio-resistant
References
n_spinalcordcomp.txt · Last modified: 2018/09/24 13:21 by wh