Lymphoma of the spine
Weakness in both legs over past 16 hours. Symptoms and signs suggestive of cord compression.
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Large plaque of mildly enhancing contiguous soft tissue in the epidural space surrounding and encroaching on the spinal cord. This extends into the exit foramen bilaterally at multiple levels.
Bilateral paravertebral and pre vertebral soft tissue, more pronounced on the left, extending into the left paraspinal muscles, but without vertebral body or rib destruction.
Signal change in the bone marrow of the adjacent T4-T6 vertebral bodies.
Symptoms of spinal cord compression is a core medical emergency meriting urgent MRI imaging.
The commonest cause is spinal metastatic disease, however it may represent the first presentation of other malignancies, such as lymphoma.
Trauma and spondylodiscitis are amongst the other multitude of causes.
In this case the contiguous nature of the soft tissue, with sparing of bone destruction in multiple anatomical spaces makes the diagnosis most in keeping with lymphoma.
The patient was transferred to a tertiary centre with both oncological and neurosurgical centres for further management.