skip to main content

Malignant Spinal Cord Compression — RACP Adult Medicine MCQ

Instant feedback + full explanation. One question, done properly.

EasyNeurologyMalignant Spinal Cord CompressionRACP Adult Medicine

A 50-year-old woman with breast cancer presents with progressive bilateral lower limb weakness and urinary retention over 48 hours. MRI spine shows an epidural mass at T8–T10 with cord compression. What is the most appropriate immediate management?

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

Reveal the answer and explanation

Correct answer: D — IV dexamethasone 16 mg stat then 4 mg QID

Malignant spinal cord compression (MSCC) is an oncological emergency. Immediate IV dexamethasone (16 mg stat) reduces peritumoural oedema and can preserve neurological function. Definitive treatment is either surgical decompression (if single-level, good performance status, expected survival >3 months) or radiotherapy. Outcome depends on pre-treatment neurological status.

Reference: Cancer Council Australia – 2024 – MSCC Guidelines; NICE 2024