Oncological Emergencies Dr. Gary Harding md, frcpc

Investigation in Clinic

• Lumbar Spine X-ray

• Some age related degeneration

Diagnosis

• Sciatica vs. Back strain

• Treatment:

• NSAIDS
• Few days of bed rest

The story continues…

• Mr. EC’s pain does not resolve

• More trials of various forms of pain control fail

• One month later Mr. EC awakens in the morning and has difficulty supporting his weight

• Subjective leg muscle weakness

• Goes to HSC Emergency room

In ER

• Patient has objective leg weakness on physical exam

• A very keen medical student does a rectal exam and discovers a large nodular prostate

• PSA: 45.0

• MRI Spine…..

Spinal Cord Compression

Malignant Epidural Spinal Cord Compression (ESCC)

• Neoplastic invasion of the space between vertebrae and spinal cord (epidural invasion)

• Usually from bone metastases

• Compresses thecal sac of spinal cord

• Frequent complication of malignancy

• Can cause pain

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