palliative care and oncology emergency

Clinical features

• known cancer Hx with onset unexplained severe back pain or difficulty mobilising
• Back pain – localised or radicular, spinal tenderness
• Sensory disturbance e.g., numbness or tingling, sensation of walking on uneven ground
• Lower limb (or occasionally upper limb) weakness, stiffness, or reduced mobility
• Urinary incontinence or retention – usually a late symptom
• Acute constipation
• perianal numbness

Examine for:

• motor weakness.
• sensory level.
• change in tone or hyperreflexia.
• upgoing plantar response.
• palpable bladder.
• perianal numbness and loss of anal sphincter tone.
• cauda equina lesion with lower motor neurone signs