A 55-year-old man with a known history of prostate cancer presents with progressive back pain, bilateral leg weakness, and urinary incontinence over three weeks. MRI shows a lesion at T10 with severe spinal cord compression from an epidural mass. What is the most appropriate initial pharmacologic management while awaiting definitive treatment?

• A Intravenous methylprednisolone (high-dose protocol)
• B Intravenous dexamethasone (16 mg/day in divided doses) ✓
• C Oral prednisolone 40 mg daily
• D Intravenous mannitol

Explanation

Metastatic epidural spinal cord compression (MESCC) is managed initially with high-dose corticosteroids, typically dexamethasone 10-100 mg IV loading followed by 16 mg/day in divided doses, to reduce peritumoral edema and improve neurological outcomes. This is distinct from the NASCIS methylprednisolone protocol used for acute traumatic SCI within 8 hours. The key distinction here is oncologic cord compression, where dexamethasone is the standard of care.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.