Malignant spinal cord compression: Difference between revisions

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==Background==
==Background==
*Suspect in pt w/ known cancer (esp lung, breast, prostate) + back pain
*Suspect in patient with known cancer (esp lung, breast, prostate) + back pain
*Occurs in thoracic location in 70% of patients
*Occurs in thoracic location in 70% of patients


==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)


==Diagnosis==
==Evaluation==
*MRI: modality of choice
*MRI: modality of choice
*CT myelography: use if MRI unavailable
*CT myelography: use if MRI unavailable
*Metastatic Bone Cancers
*Metastatic Bone Cancers
**BTL w/ Pickles and Relish: Breast, Thyroid, Lung, Prostate, Renal
**BTL with Pickles and Relish: Breast, Thyroid, Lung, Prostate, Renal


==Differential Diagnosis==
==Differential Diagnosis==
{{Oncologic emergencies DDX}}
{{Oncologic emergencies DDX}}


==Treatment==
==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)
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==See Also==
==See Also==
[[Spinal Cord Compression (Non-Traumatic)]]
[[Spinal Cord Compression (Non-Traumatic)]]
 
[[Cauda equina
==References==
==References==
<references/>
<references/>

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

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

Related to Biochemical Derangement

Related to Hematologic Derangement

Related to Therapy

Management

  1. Corticosteroids
    1. Dexamethasone 10mg IV followed by 4mg PO or IV q6hr
    2. Consider starting in ED if imaging is delayed
  2. Radiotherapy (emergent)

See Also

Spinal Cord Compression (Non-Traumatic) [[Cauda equina

References