Neuroscience/Spinal and leptomeningeal metastases
From IKE
Contents |
Objectives
- Know the presenting symptoms and sign of epidural metastatic spinal cord compression
- Know the treatment options and prognosis for spinal cord compression
- Know the different presentations of spinal metastases (metastatic spinal cord compression) and degenerative spinal disease
Wikipedia
Exam
Epidural Spinal Cord Compression
Principles
- High index of suspicion
- Early investigation
- Speedy treatment
Location
- Thoracic (60-75%)
- Lumbar (20-30%)
- Cervical (10-15%)
- Multiple levels (10-25%)
Symptoms
- Pain (tenderness) - 96%; back or neck especially (>95% patients)
- Location: Central back or neck; Radicular; Band, around chest or abdomen
- Progressive
- Steady, aching, sharp, lancinating (occasionally)
- Not relieved by lying, rest
- Weakness - 6%
- Reflex change; Autonomic dysfunction; Sensory loss; Ataxia; Herpes zoster
Investigations
- Spine films
- Isotope bone scan
- Myelogram
- CT scan
- MRI
- CSF analysis
Treatment
- Analgesics
- Corticosteroids
- Radiotherapy
- Surgery:
- Laminectomy
- Anterior vertebral body resection
- Stabilization
- Chemotherapy
- Surgery + radiation is better than radiation alone
Prognosis depends on condition before treatment (i.e. higher chance to be ambulatory after if ambulatory before)
Leptomeningeal metastases
- This is a cancerous meningitis
- The Overall incidence increasing due to longer survival
Diagnosis
- Clinical
- Imaging
- CSF analysis - 50% metastatic cells on first LP; 80% on 3rd
Symptoms and signs
- Cerebral (50%)
- Cranial nerve (50%)
- Spinal (75%)
- Due to the neoplastic cell invasions of the spinal canal, cortex, etc.
