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For further information, see CMDT Part 24-10: Intracranial & Spinal Mass Lesions

Key Features

Essentials of Diagnosis

  • Pain, especially with extradural lesions

  • Weakness, sensory disturbances, and reflex changes below the level of the lesion

  • Bladder, bowel, and sexual dysfunction may occur

General Considerations

  • Approximately 10% of spinal tumors are intramedullary

  • Ependymoma is the most common type of intramedullary tumor; the remainder are other types of glioma

  • Extramedullary tumors may be extradural or intradural in location

  • Among the primary extramedullary tumors, neurofibromas and meningiomas are relatively common and benign and may be intradural or extradural

  • Carcinomatous metastases, lymphomatous or leukemic deposits, and myeloma are usually extradural

  • Common primary sites for metastases

    • Prostate

    • Breast

    • Lung

    • Kidney

Clinical Findings

Symptoms and Signs

  • Tumors may lead to spinal cord dysfunction by

    • Direct compression

    • Ischemia secondary to arterial or venous obstruction

    • Invasive infiltration in the case of intramedullary lesions

  • Symptoms usually develop insidiously

  • Pain with extradural lesions

    • Characteristically aggravated by coughing or straining

    • May be radicular, localized to the back or felt diffusely in an extremity

    • May be accompanied by motor deficits, paresthesias, or numbness, especially in the legs

    • Often precedes specific neurologic symptoms in epidural metastases

  • Sphincter disturbances may occur

  • Localized spinal tenderness

  • Segmental lower motor neuron deficit or dermatomal sensory changes (or both) may be found at the level of the lesion

  • An upper motor neuron deficit and sensory disturbance are found below it

Differential Diagnosis

  • Primary tumor, eg, ependymoma, meningioma, neurofibroma

  • Lymphoma, leukemia, plasma cell myeloma

  • Metastases, eg, cancer of the prostate, breast, lung, kidney

  • Cervical or lumbar disk disease

  • Multiple sclerosis

  • Tuberculosis (Pott disease)


Laboratory Tests

  • Cerebrospinal fluid

    • Is often xanthochromic

    • Contains a greatly increased protein concentration

    • Has normal cell content and glucose concentration

Imaging Studies

  • MRI with contrast or CT myelography

    • Used to identify and localize the lesion

    • Combination of known tumor elsewhere in the body, back pain, and either abnormal plain films of the spine or neurologic signs of cord compression is indication to perform studies urgently



  • Dexamethasone in high dosage (eg, 10–96 mg once intravenously, followed by 4–25 mg four times daily for 3 days orally or intravenously, followed by rapid tapering of the dosage, depending on initial dose and response) to reduce cord swelling and relieve pain


  • Intramedullary tumors are treated by decompression and surgical excision (when feasible) and by radiation

    • Prognosis depends on the cause and severity of cord compression before it is relieved

  • Surgical decompression for epidural metastases is reserved for

    • Tumors that are ...

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