QuestionSBA
QuestionChoice
This is correct. The patient is presenting with signs and symptoms of metastatic spinal cord compression, an emergency which requires immobilisation, urgent high-dose steroids to limit oedema and urgent spinal imaging to characterise the level and nature of compression.
10035607
a
Immobilise the patient and administer 16mg of dexamethasone
QuestionChoice
This would certainly form part of managing this patient but is not the initial priority in the emergency department.
10035608
b
Arrange urgent oncology review
QuestionChoice
A whole spine MRI is required urgently within 24 hours to assess for spinal cord compression and to characterise the levels of compression.
10035611
e
Request an emergency lumbar spine MRI
QuestionChoice
Surgical options would likely be discussed in a multidisciplinary setting once imaging has characterised any spinal lesions.
10035609
c
Arrange urgent spinal surgical review
QuestionChoice
This is not appropriate as patients with suspected cord compression must be immobilised to stabilise the spinal column after possible injury and thus prevent further spinal cord damage.
10035610
d
Encourage mobilisation and administer 8mg dexamethasone
Concept
Chapter
2693
6146
Emergency management of suspected acute spinal cord compression
Topic
141
Neurology
19525
Metastatic spinal cord compression presents with severe back pain, leg weakness, and incontinence, requiring urgent immobilisation and high-dose steroids.
A 58-year-old gentleman is brought into the emergency department by ambulance after losing the ability to walk over the last few days. He describes severe lower back pain, incontinence and profound leg weakness bilaterally. On examination, power in his legs is MRC Grade 1/5 bilaterally. He is known to have renal cell carcinoma and is undergoing chemotherapy.

What is the most appropriate initial course of action?
a