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Spinal Cord Compression — RACP Adult Medicine MCQ

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HardNeurologySpinal Cord CompressionRACP Adult Medicine

A 50-year-old man presents with a 3-week history of progressive bilateral lower limb weakness, back pain, and urinary retention. Examination shows UMN signs in both legs with a sensory level at T8. MRI shows an enhancing intradural extramedullary mass at T7-8. What is the most likely diagnosis?

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Correct answer: B — Meningioma

An intradural extramedullary mass causing spinal cord compression in a 50-year-old is most likely a meningioma (most common intradural extramedullary tumour, more common in women) or schwannoma. The enhancing nature and location are characteristic. If the mass were intramedullary, astrocytoma or ependymoma would be considered. Metastatic deposits are typically extradural. Urgent neurosurgical referral is required.

Reference: eTG – 2025 – Neurology; NICE – 2023 – Spinal Cord Compression Guidelines