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Neurological emergencies 

Neurological emergencies
Chapter:
Neurological emergencies
Author(s):

Spence Roy A.J.

, and Johnston Patrick G.

DOI:
10.1093/med/9780199215638.003.0005
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date: 20 October 2019

Malignant extradural spinal cord compression 194

Raised intracranial pressure 206

Leptomeningeal metastases 214

Spinal cord compression (SCC) occurs in 5–10% of all patients with a known diagnosis of malignancy but may be the first presentation of malignancy in up to 20%.

This common but devastating complication of metastatic cancer can result in paraplegia and sphincter dysfunction. Of patients who are ambulatory at diagnosis, 80–100% can preserve this level of function. Once lost, ambulation is regained in less than 25% of patients. The strongest predictor of post-treatment neurological function and survival is pre-treatment neurological function; therefore the most important intervention for improving the outcome from SCC is early detection of symptoms and the education of patients to report symptoms. One study has shown a median delay in diagnosis of 2 months from the onset of back pain and 10 days from developing symptoms of cord compression, during which one grade of bladder or neurological function was lost....

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