Dados do Resumo

Título

THE IMPORTANCE OF NEUROLOGICAL CLINICAL EXAMINATION FOR THE EARLY DIAGNOSIS OF METASTATIC SPINAL COMPRESSION SYNDROME IN ONCOLOGICAL PATIENTS

Introdução

Spinal cord compression is a serious complication of advanced-stage cancer, often caused by the resulting metastatic lesions, posing an exponential challenge in the area of ​​Oncology Medicine. Given the non-specificity of their clinical presentations and the importance of early analysis, the evaluation of the neurological examination of these patients becomes a notable object of study, so that significant changes in the quality and life expectancy of those affected are minimized.

Objetivo

To gather and analyze, in light of the current literature, the essential factors in the clinical neurological examination of cancer patients that suggest the early diagnosis of metastatic spinal cord compression syndrome.

Métodos

This is an integrative literature review, carried out in August 2024, with articles indexed in the LILACS and MEDLINE databases, available on the Regional Portal of the Virtual Health Library (VHL) and PUBMED. The Health Sciences Descriptors (DeCS) were used: “spinal cord compression”, “early diagnosis” and “prognosis”, with the Boolean operator AND to cross between the terms. 72 studies were found through the search strategy and 15 were used for this review. Clinical studies, case series and complete articles reporting clinical cases related to spinal cord compression associated with metastasis, published in English and between 2019 and 2024, were included. Incomplete texts, studies on spinal cord compression due to causes other than metastases, duplicate studies, unrelated case reports, literature reviews and previous meta-analyses were deleted.

Resultados

Several studies corroborate the association between a thorough neurological clinical examination and the early detection of signs and symptoms suggestive of metastatic spinal cord compression syndrome. Although the articles reviewed are in agreement regarding the importance of this analysis as a starting point for medical investigation, they also highlight that it is insufficient to make a diagnosis. However, early recognition of clinical changes serves as a warning to avoid future serious neurological sequelae. In this sense, the most prevalent clinical findings in this review are cited: mechanical pain - aggravated when standing, sitting or moving -, back pain aggravated by effort - coughing, sneezing, bowel movements or the Valsalva maneuver -, localized sensitivity , balance and motor weakness, bladder or bowel dysfunction, as well as neurological deficits, occurring weeks to months after the onset of back pain, such as weakness, tingling or numbness in the arms or legs.

Conclusões

Careful and early clinical neurological assessment in cancer patients is a pillar for the prior diagnosis of metastatic spinal cord compression syndrome, which, if not treated appropriately, can lead to irreversible deficits. Therefore, it is essential to expand curricular studies with the proposal to include standardized clinical protocols that integrate the main elements of the neurological examination, in order to improve the prognosis and quality of life of affected patients.

Palavras Chave

Spinal cord compression; Neurological clinical examination; Early diagnosis