Cord compression – exam presentation

How to present a patient with a cord lesion for doctors, medical school exams, OSCEs, MRCP PACES and USMLE

• Mr Anderson has a background of known metastatic prostate cancer.
• He presented with pain in his lower back, tingling in his legs and difficulty passing urine.
• On examination of the lower limbs tone was increased.
• Power was decreased at 3/5 in both legs.
• There was bilateral hyperreflexia, and extensor plantars.
• He had a global loss of sensation to the level of L1. There was also decreased anal tone on digital rectal examination.
• There was tenderness on palpation of the thoracic and lumbar spine.
• These signs are consistent with spinal cord compression above the L1 spinal cord level. The history would be suggestive of a metastatic process underlying this.
• This is a medical emergency. I would go on to organise emergency imaging (MRI whole spine) and activate the MSCC pathway [if available]. Treatment acutely with steroids (e.g. dexamethasone 8mg BD with a PPI) followed by neurological input may be needed.

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Perfect revision for medical student finals, OSCES and PACES