Paraparesisspinal collapse

May be due to tumour in the cord, spinal dura or meninges or by extension of a vertebral tumour into the spinal canal with compression of the cord or as a result of vertebral collapse.

Spinal cord compression from vertebral collapse in a haematological patient is most commonly due to myeloma (in up to 20% of patients) but may occur in a patient with Hodgkin's disease (3-8%) or occasionally non-Hodgkin's lymphoma. Spinal cord involvement by leukaemia is most common in AML, less so in ALL and CGL and least common in CLL.

Onset of paraplegia may be preceded for days or weeks by paraesthesia but in some patients the onset of paraplegia may follow initial symptoms by only a few hours.

Symptoms suggestive of spinal cord compression require urgent assessment by CT or MRI and referral to a neurosurgical unit for assessment for surgical decompression. Where this is not possible early radiotherapy may provide symptomatic improvement. However, if treatment is delayed until paraparesis has developed, this often proves to be irreversible despite surgery and/or radiotherapy.

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