SAQ 419 – Neurosurgery – acute thoracic spinal cord compression
Model Answer
Neurosurgery – acute thoracic spinal cord compression.
a. Key differences
| Guillain-Barre syndrome | Acute spinal cord compression |
|---|---|
| Ascending symmetrical weakness, often after infection. | Weakness depends on cord level and may be asymmetric. |
| Areflexia or hyporeflexia is typical. | Upper motor neuron signs may occur below the lesion; reflexes can be brisk after spinal shock evolves. |
| No clear sensory level. | Sensory level is typical. |
| Sphincter involvement is less prominent early. | Sphincter dysfunction is common and important. |
| Back pain is not usually the dominant feature. | Back pain or radicular pain may be present. |
b. Most likely diagnosis
- Acute spinal cord compression at approximately T4/upper thoracic level.
c. Potential causes
- Malignancy, either primary or metastatic.
- Infection such as epidural abscess or discitis.
- Degenerative disc disease or spondylosis.
- Trauma, especially if there is a relevant mechanism or pathological fracture.
- Vascular causes such as spinal ischaemia related to aortic pathology.
- Inflammatory or demyelinating disease, noting this may mimic rather than mechanically compress the cord.
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