ABSTRACT
This chapter presents a case study of a 54-year-old man who is receiving immunotherapy for metastatic bladder cancer with known liver and lung metastases presents to the Emergency Department with increasing mid-back pain. Acute back pain is not an uncommon reason for presentation to the Emergency Department, and the ability to determine if it requires urgent evaluation and possible admission to the hospital is an important skill. In this case, the history of active cancer together with the neurologic findings point strongly to a diagnosis of malignant spinal cord compression (MSCC). MSCC is an oncologic emergency, and most institutions have protocols that guide clinicians through the investigations and immediate management when it is suspected. In this patient, a comprehensive neurologic examination at presentation is paramount, as it will serve as a baseline. Once MSCC is suspected, the patient should receive corticosteroids with gastric protection; typically, IV dexamethasone at a dose between 8 and 16 mg is administered.
