Case history
Case history #1
A 60-year-old woman with breast cancer presents with back pain that has gradually increased in severity over the last 3 weeks. The pain is worse when she lies down. She has found walking more difficult in the last few days, with a feeling of numbness in her toes. Loss of tendon reflex is apparent on exam. A consistent reduction in grade is observed on the Medical Research Council manual muscle test scale.
Case history #2
A 70-year-old man without a pre-existing diagnosis presents with radicular back pain that has worsened over time. He smokes 20 cigarettes a day and has a persistent cough, which makes the back pain worse. He says he feels unsteady on his feet. Loss of pinprick sensation and hyperreflexia are observed on exam.
Other presentations
Back pain is the most common symptom associated with MSCC (>95% of patients at diagnosis), followed by motor weakness (35% to 85%), and sensory impairments (around 60%).[2][3] Symptoms associated with MSCC depend on the spinal segments affected and the spinal tracts involved. Sensory symptoms may include paresthesias, pins and needles, loss of light touch sensation, loss of temperature sensation, and loss of proprioception. Patients may develop bladder dysfunction with symptoms such as urinary frequency, urgency, hesitancy, and/or incontinence. They may experience bowel dysfunction with symptoms of diarrhea, constipation and/or incontinence. Several spinal cord syndromes related to MSCC have been reported, including anterior cord, posterior cord, Brown-Sequard, central cord, conus medullaris, and cauda equina syndromes.[1][4]
Cauda equina syndrome (CES) is typically characterized by decreased sensation over the buttocks, thighs, and perineal region, in a saddle distribution, with decreased anal sphincter tone on examination. Bladder dysfunction is always present at some stage in the progression of CES.[5][6] Early presentation may be a reported difficulty in starting or stopping the urine stream, urgency, loss of urge to urinate, or reduced awareness of a full bladder or of passing urine. Later symptoms are urinary retention and overflow incontinence. The rare Brown-Sequard syndrome is characterized by unilateral spastic paralysis on the same side of the body, ipsilateral loss of vibration and proprioception (position sense), and loss of pain and temperature sensation from the contralateral side beginning 1 or 2 segments below the lesion. The bulbocavernosus reflex can be affected or absent (in both sexes). See Cauda equina syndrome.
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