Tumor-Induced Paraplegia

Tumor-Induced Paraplegia is a topic covered in the Pocket ICU Management.

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First Things First (assess & treat for the following)

  • The vast majority of cases of tumor-induced paraplegia are from metastatic epidural spinal cord compression (MESCC).
    • Cord compression (CC) is a relatively common CNS complication of cancer.
      • 1/3 of all cancer pts get secondary spinal tumors; 3rd behind liver & lung.
      • 5% of pts who die of cancer get MESCC.
      • 18K new cases in North America each yr.
    • Metastatic presentations are 20 times more common than primary tumors of the cord.
      • Initial manifestation in 10% of cancer pts.
      • Most frequent primaries: breast, lung, prostate, hematopoietic system, renal
      • 95% of spinal mets are extradural.
        • Hematogenous spread to vertebral bodies.
        • CC when spreads to epidural space.
        • Rare etiologies of MESCC: paraspinous extension, marrow replacement (myeloma), foraminal invasion (lymphoma).
        • Rare etiologies of tumor-induced paraplegia.
    • Intradural metastases (<5%) can be either within the cord (intramedullary) or extramedullary.
    • Primary spinal cord tumors (about 1/100,000) are very rare. Don’t usually present w/ paraplegia.
    • Anatomically possible though rare causes of tumor-induced paraplegia are midline cerebral lesions w/ bifrontal involvement. The motor areas of the lower extremities are located next to each other midline on the precentral gyrus.

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Last updated: May 16, 2010