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Transcript
Internal Medicine
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Commonest cause of neoplastic compression of spinal cord in adults. Usually
results from metastasis to adjacent vertebral bone or direct compression of the
spinal cord.
ƒ
Commonest neoplasm include: breast, lung, prostate, kidneys, lymphoma and
multiple myeloma
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Most frequently involved site is thoracic cord
ii) Intradural: inside the dural layer
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These are slowly growing benign tumors like meningioma, neuroblastoma,
lipoma
2) Intra medullary: tumors within the spinal cord.
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These are uncommon tumors , including ependymoma, hemangioblastoma low
grade astrocytoma
Clinical feature
•
Initial symptom is backache, which is localized, and which worsens with movement,
coughing or sneezing. The pain may radiate to the legs, trunk or following dermatomal
distribution.
•
The pain may be sever and awaken the patient at night.
•
As
compression
progresses
patient
develops
progressive
weakness,
sensory
abnormalities and autonomic disturbances change in bladder function and constipation.
Physical findings include:
•
Weakness, spasticity, hyperreflexia
•
Loss of or decreased sensations to pinprick in the lower extremities
•
Extensor plantar response , and loss of abdominal reflexes and anal sphincter tone
•
Urinary retention
Investigations
•
Check for primary tumor sites
•
Plain X-ray of the spine
•
Myelography
•
Radionuclide bone scan
•
CT/MRI
•
Biopsy Æ usually unnecessary in patients with known pre-existing cancer.
Therapy: depends on site and type of tumor.
Treatment modalities include
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