CURRENT Essentials of Critical Care.pdf

280 Current Essentials of Critical Care■■■Spinal Cord CompressionEssentials of Diagnosis• Dull aching axial back pain that may radiate to arms or legs;band-like discomfort around chest; worse at night; aggravatedby movement• Neurologic deficits depend on level of involvement: 70% thoracic,20% lumbar, 10% cervical; typically begins with motorimpairment; high cervical cord lesions may be life-threatening;thoracic cord lesions have truncal sensory level, lower extremityweakness, autonomic dysfunction; lumbosacral cord lesionsmay have radiculopathy and loss of reflexes or conus syndrome• Acquire imaging studies as soon as possible; MRI, or CT myelogram• May be first manifestation of malignancy; most common arecancers of lung, breast, prostate, lymphoma, multiple myeloma• Epidural spinal cord compression develops from direct metastaticspread of cancer to vertebral body or from paravertebrallocation with extension into epidural spaceDifferential Diagnosis• Intervertebral disk herniation • Spinal cord infarction• Benign neoplasms • Multiple sclerosis• Transverse myelitis • Epidural abscess• Paraneoplastic syndrome • Carcinomatous meningitisTreatment• Corticosteroids should be started as soon as diagnosis suspected;delay may lead to progression of neurologic deficit• External beam radiation to involved area• Chemotherapy based on underlying malignancy• Surgery indicated for spinal instability or bone deformity, failureto respond to radiation therapy, radioresistant tumor, atlantoaxialcompression, solitary spinal cord metastasis• Monitor changes in neurologic exam closely■ PearlEpidural spinal cord compression should be considered in any patientwith cancer and axial skeletal pain as pain is the most common earlysymptom.ReferenceDaw HA et al: Epidural spinal cord compression in cancer patients: diagnosisand management. Cleve Clin J Med 2000;67:497. [PMID: 10902239]