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Neurological Emergencies—What is going on?

This man is developing spinal cord compression due to an epidural metastatic tumor.

The syndrome deals with back pain and any sort of leg or bowel/bladder complaint in a person who either has or should have cancer.

At first, the symptoms are insidious and likely to be brushed off, but deterioration can occur with frightening rapidity. This sort of history/PE syndrome should prompt a rapid MR survey of the entire spine (your neuroradiologist will know what to do).

If it's clean, great. If it shows metastatic tumor, you have made your patient's last few months on earth much more livable.

If you ignore this developing syndrome, you are likely to see the patient next in the ER, having been paraplegic for 24 hours. At this point, treatment is very unlikely to restore ambulation, so his last few months will be spent in a wheelchair.