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Metastatic Spinal Cord Compression — SCE Neurology MCQ

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HardNeuro-oncologyMetastatic Spinal Cord CompressionSCE Neurology

A patient with known prostate cancer develops severe thoracic pain, new bilateral leg weakness and urinary retention. MRI confirms metastatic epidural spinal-cord compression at T8. What should occur immediately while definitive treatment is arranged?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — Dexamethasone 16 mg with urgent oncology and surgical review

The best answer is “Dexamethasone 16 mg with urgent oncology and surgical review”. Neurological metastatic cord compression is an oncological emergency; prompt dexamethasone reduces oedema while urgent multidisciplinary assessment selects surgery, radiotherapy and stabilisation. “defer intervention until histology before giving corticosteroid despite neurological deficit” is less appropriate because delaying treatment risks irreversible neurological loss when compression is already demonstrated “Arrange outpatient radiotherapy review after a two-week analgesic trial” is less appropriate because outpatient delay is inappropriate with evolving motor and sphincter dysfunction “Perform lumbar puncture below the compressed level before treatment” is less appropriate because lumbar puncture does not guide initial management and may add risk “Begin routine physiotherapy without spinal-stability or definitive-treatment review” is less appropriate because mobilisation decisions require stability assessment and cannot replace decompression or radiotherapy

Reference: NICE NG234: Spinal metastases and metastatic spinal cord compression. https://www.nice.org.uk/guidance/ng234/chapter/Recommendations