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Spinal cord compression from metastasis — SCE Neurology MCQ

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ModerateNeuro-oncologySpinal cord compression from metastasisSCE Neurology

A 48-year-old man presented with back pain followed by rapidly progressive leg weakness in prostate cancer. On examination, there was a sensory level and urinary retention. Initial investigations showed: MRI whole spine showed thoracic epidural compression. What is the most appropriate investigation?

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Correct answer: C — MRI brain with gadolinium

MRI brain with gadolinium is the best answer because the vignette describes Spinal cord compression from metastasis: cancer with back pain and cord signs indicates metastatic spinal cord compression. CT angiography of the head and neck is plausible in a neighbouring presentation, but the chronology, examination or investigation pattern does not match the key discriminator here. Nerve conduction studies and EMG and MR venography are less appropriate because they would require different localisation, timing or test findings; Genetic testing after counselling would fit a different syndrome. Clinical pearl: peripheral neuropathy would not cause a sensory level or sphincter involvement.

Reference: NICE NG99; EANO guidance; ABN paraneoplastic guidance