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Sudden Bilateral Lower Extremity Weakness With Hemodynamic Instability


Consult Page

60M h/o metastatic prostate cancer presenting with leg weakness, MRI with abnormal T2 signal and enhancement, thoracic compression fracture

Initial Imaging

Fig. 44.1, A. A T2-weighted MRI of the cervical and thoracic spine without contrast demonstrates a T2-hyperintense signal extending from approximately T1-T7 (arrow). B. A sagittal pan-spine MRI shows multifocal bony metastatic disease, most notably at T5 and T7 without significant canal compromise.

Walking Thoughts

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    What is the patient’s neurological exam?

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    What is the onset and progression of the patient’s weakness (acute versus chronic)? Is the patient having any other symptoms (e.g. numbness, bowel/bladder dysfunction, saddle anesthesia)?

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    What is the patient’s prostate cancer history? Where are the known sites of metastasis?

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    What treatment has the patient undergone? Has the patient received spinal radiation?

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    What other medical history does the patient have? Do these alter the differential diagnosis?

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    The spine MRI does not show obvious spinal cord compression, but rather abnormal signal within the intrinsic spinal cord. What can cause this? Does this explain the patient’s physical exam and presentation?

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    What additional studies will be necessary to determine whether or not surgery is necessary?

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    Does the patient take any antiplatelet or anticoagulant medications?

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