Epidural compression syndromes: Difference between revisions
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*Back pain with neuro deficits | *Back pain with neuro deficits | ||
**Weakness in lower extremities, paresthesias/sensory deficits, gait difficultly | **Weakness in lower extremities, paresthesias/sensory deficits, gait difficultly | ||
*Cauda equina syndrome | *[[Cauda equina syndrome]] | ||
**Urinary retention with or without overflow incontinence (Sn 90%, Sp 95%) | **Urinary retention with or without overflow incontinence (Sn 90%, Sp 95%) | ||
**Rectal incontinence | **Rectal incontinence | ||
Revision as of 18:03, 3 February 2014
Background
- Includes spinal cord compression, cauda equina syndrome, conus medullaris syndrome
- Presentation and initial management are similar; difference is level of neuro deficit
Etiology
- Epidural abscess
- Malignancy
- Massive mid-line disk herniation
- Spinal canal hemorrhage
Clinical Features
- Back pain with neuro deficits
- Weakness in lower extremities, paresthesias/sensory deficits, gait difficultly
- Cauda equina syndrome
- Urinary retention with or without overflow incontinence (Sn 90%, Sp 95%)
- Rectal incontinence
- Bilateral sciatica
- Saddle anesthesia
- Decreased anal sphincter tone (60-80% pts)
- Symptoms worsened by coughing (increases intraspinal pressure)
Management
- Dexamethasone 10mg IV (give before obtaining any confirmatory tests)
- MRI
- If considering compression due to neoplasm obtain scan of entire spine
- Radiation therapy
- If due to neoplasm
Source
- Tintinalli