Malignant spinal cord compression: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
*Back pain (90% of patients) | *[[Back pain]] (90% of patients) | ||
**Progressive and worse when supine | **Progressive and worse when supine | ||
*Motor weakness (proximal legs) | *Motor [[weakness]] (proximal legs) | ||
*Sensory changes and bladder or bowel dysfunction (late findings) | *[[numbness|Sensory changes]] and bladder or bowel dysfunction (late findings) | ||
== | ==Evaluation== | ||
*MRI: modality of choice | *MRI: modality of choice | ||
*CT myelography: use if MRI unavailable | *CT myelography: use if MRI unavailable | ||
| Line 19: | Line 19: | ||
==Management== | ==Management== | ||
#Corticosteroids | #[[Corticosteroids]] | ||
##Dexamethasone 10mg IV followed by 4mg PO or IV q6hr | ##[[Dexamethasone]] 10mg IV followed by 4mg PO or IV q6hr | ||
##Consider starting in ED if imaging is delayed | ##Consider starting in ED if imaging is delayed | ||
#Radiotherapy (emergent) | #Radiotherapy (emergent) | ||
Latest revision as of 04:48, 1 October 2019
Background
- Suspect in patient with known cancer (esp lung, breast, prostate) + back pain
- Occurs in thoracic location in 70% of patients
Clinical Features
- Back pain (90% of patients)
- Progressive and worse when supine
- Motor weakness (proximal legs)
- Sensory changes and bladder or bowel dysfunction (late findings)
Evaluation
- MRI: modality of choice
- CT myelography: use if MRI unavailable
- Metastatic Bone Cancers
- BTL with Pickles and Relish: Breast, Thyroid, Lung, Prostate, Renal
Differential Diagnosis
Oncologic Emergencies
Related to Local Tumor Effects
- Malignant airway obstruction
- Bone metastases and pathologic fractures
- Malignant spinal cord compression
- Malignant Pericardial Effusion and Tamponade
- Superior vena cava syndrome
Related to Biochemical Derangement
- Hypercalcemia of malignancy
- Hyponatremia due to SIADH
- Adrenal insufficiency
- Tumor lysis syndrome
- Carcinoid syndrome
Related to Hematologic Derangement
Related to Therapy
- Chemotherapy-induced nausea and vomiting
- Cytokine release syndrome
- Chemotherapeutic drug extravasation
- Differentiation syndrome (retinoic acid syndrome) in APML
- Stem cell transplant complications
- Catheter-related complications
- Tunnel infection
- Exit site infection
- CVC obstruction (intraluminal or catheter tip thrombosis)
- Catheter-related venous thrombosis
- Fracture of catheter lumen
- Oncologic therapy related adverse events
Management
- Corticosteroids
- Dexamethasone 10mg IV followed by 4mg PO or IV q6hr
- Consider starting in ED if imaging is delayed
- Radiotherapy (emergent)
See Also
Spinal Cord Compression (Non-Traumatic) [[Cauda equina