18.6Spinal Cord Compression

18.6.1 General

• Differential diagnosis of malignancies: neuroblastoma, non-Hodgkin lymphoma, metastatic brain tumor, neuroectodermal tumors, metastases, Langerhans cell histiocytosis

18.6.2 Diagnosis

•Symptoms: local or radicular back pain, local tenderness to percussion, loss of motor strength of the upper and/or lower extremities (according to location of the compression), sensory loss, urinary retention

•Laboratory analysis: Complete blood count with differentiation of leukocytes

•Sodium, potassium, calcium, magnesium, urea, creatinine, phosphorus, uric acid, LDH

•Radiology: Chest X-ray and possibly abdominal X-ray: rule out space-occupying process, control of spinal integrity

•MRI: extraand/or intraspinal tumor

•Possibly CT scan (multislice technology), interpretation of skeletal structures

18.6.3 Treatment

•Consult neurologist, oncologist and neurosurgeon

•Dexamethasone, initially 0.2–0.4 mg/kg, then 0.3 mg/kg/day in three or four doses/ day. Consider immediate surgery or radiotherapy, although rarely indicated

•Diagnostic algorithm in collaboration with oncologist (e.g., biopsy of lymph nodes, bone marrow aspiration, thoracocentesis, pleurocentesis)

18.7Superior Vena Cava Syndrome

and Superior Mediastinal Syndrome

18.7.1 General

•Compression of superior caval vein. Rare in pediatrics. Oncological/hematological etiology: mediastinal tumors (non-Hodgkin lymphoma, neuroblastoma, Hodgkin lymphoma, sarcomas, germ cell tumors, and others), thrombosis (often in association with central vein catheters), hereditary thrombophilia, drugs (e.g., asparaginase)