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Picture Quiz: Spinal cord compression

BMJ 2003; 326 doi: (Published 01 March 2003) Cite this as: BMJ 2003;326:030358
  1. Deborah King, consultant in medicine for the elderly1,
  2. Barbara Hammer, Arrowe Park Hospital2
  1. 1Arrowe Park Hospital, Upton, Wirral CH49 5PE
  2. 2Upton, Wirral CH49 5PE

Case history

An 82 year old man was admitted to the emergency department with pain in his back. He had a past medical history of hypertension, which was well controlled, and he complained of nocturia--he got up four times a night for the last six months.

The initial physical examination including neurological examination was unremarkable. His full blood count, electrolytes, and liver function tests were normal. A plain x ray of his thoracic spine reveaved a vertebral collapse of T6. Six days after admission, he was unable to move his right leg and was catheterised because of urinary retention. Examination found reduced power in his right leg and decreased reflexes but no sensory deficit.


  1. What are the features seen on the magnetic resonance images (figs 1 and 2)?

  2. What is the probable diagnosis?

  3. How would you confirm the diagnosis?

  4. How would you treat this patient?

  5. What is the prognosis?

Figure 1
Figure 2


  1. Spinal cord compression caused by a tumour in the T6 vertebral body.

  2. The tumour is most likely to be secondary to another in the body. Primary tumours of the cord are uncommon. Given the patient's age and history of nocturia, it is likely that the primary tumour is prostatic in origin.

  3. Physical examination of the rectum may show an enlarged prostate with an irregular …

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