Spinal cord compression

[Greyhame]

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Uworld says that in case of spinal cord compression that patient should be started on steroids and an MRI should be done ASAP. Is it true for all cases or just in case of metastatic disease?
Because I recently read somewhere that in cord compression due to epidural abscess, steroids are contraindicated. You instead give antibiotics and drain it surgically.

 

[serenity52]

Uworld says that in case of spinal cord compression that patient should be started on steroids and an MRI should be done ASAP. Is it true for all cases or just in case of metastatic disease?
Because I recently read somewhere that in cord compression due to epidural abscess, steroids are contraindicated. You instead give antibiotics and drain it surgically.

Both are questions from Uworld. Steroids are indicated only in case of metastatic disease to reduce the compressive edema. In infection, it will be propably harm the patient more so you only give antibiotics

You still give steroids IV in bacterial meningitis though (just to make it clear). But it has been proven to be beneficial only for a) adults with S.pneumoniae and b) children with H.Influenza

Please let me know if I am wrong.

 

[Greyhame]

Both are questions from Uworld. Steroids are indicated only in case of metastatic disease to reduce the compressive edema. In infection, it will be propably harm the patient more so you only give antibiotics

You still give steroids IV in bacterial meningitis though (just to make it clear). But it has been proven to be beneficial only for a) adults with S.pneumoniae and b) children with H.Influenza

Please let me know if I am wrong.

Makes sense, I guess. Antibiotics plus drainage seems to be the general treatment for abscesses anywhere in the body. I'm not even sure if the question mentioned any signs of cord compression with the abscess.

Yes, you are right. I need to make some corrections in my treatment algos. Thanks. 🙂

 

[evilbooyaa]

Emergent MRI first to diagnose why they have cord compression. Depending on the reason, treat appropriately as you've noted.