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Metastatic Cauda Equina Compression – Emergency Management — SCE Neurology MCQ

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EasyNeuro-oncologyMetastatic Cauda Equina Compression – Emergency ManagementSCE Neurology

A 70-year-old man presents with a 2-week history of progressive bilateral lower limb weakness with back pain. He has reduced perianal sensation, loss of anal tone, and urinary retention. MRI lumbar spine shows an enhancing mass compressing the cauda equina at L3–L5. His PSA is elevated. CT chest/abdomen shows a prostate mass with bony metastases. What is the most urgent management step?

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Correct answer: D — Oral dexamethasone 16 mg daily and urgent oncological referral for radiotherapy

Metastatic spinal cord/cauda equina compression is a neurological emergency. The NICE guideline on metastatic spinal cord compression (CG75) recommends immediate high-dose corticosteroids (dexamethasone 16 mg daily) to reduce oedema, followed by urgent radiotherapy or surgical decompression (within 24 hours if the patient is a surgical candidate). The functional outcome depends critically on the neurological status at the time of treatment — early intervention preserves function. B: Outpatient management is inappropriate for cauda equina compression. C: Chemotherapy does not provide rapid decompression. D: LP is contraindicated with a compressive mass. E: Watchful waiting risks permanent paraplegia.

Reference: NICE CG75 Metastatic Spinal Cord Compression (2008)