Neurology

	Answer 4 T10 vertebral body metastatic lesion causing epidural spinal cord compression. Bilateral leg involvement without arm symptoms indicates a spinal lesion below the level of the cervical spine. Upper motor neuron signs (ie, hyperreflexia and Babinski’s sign) as well as a sensory deficit up to the umbilicus indicate a lesion in the thoracic spinal cord. A lesion in the lumbar spine affecting the cauda equina (which begins at the L1 level) would be expected to produce lower motor neuron deficits (ie, hyporeflexia) and sensory loss confined to the legs. Vertebral metastasis with spinal cord compression is a common initial herald of metastatic disease; the thoracic spine is the most common location of such lesions.4,5 REFERENCES 4. Posner J. Neurologic complications of cancer (contemporary neurology series). Philadelphia: FA Davis Company; 1995. 5. Gabriel K, Schiff D. Metastatic spinal cord compression by solid tumors. Semin Neurol 2004;24:375-83. Click here to return to the questions
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