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Revista de la Asociación Médica del Centro Médico ABC

2021, Número 4

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An Med Asoc Med Hosp ABC 2021; 66 (4)


Compresión maligna de la médula espinal y los cambios microvasculares inducidos

Shveid GD, Noguez RA, Moreno JS

Idioma: Ingles.
Referencias bibliográficas: 78
Paginas: 273-282
Archivo PDF: 264.86 Kb.


RESUMEN

La compresión de la médula espinal es considerada una emergencia neurooncológica. Cualquier paciente oncológico con dolor en la columna debe recibir una evaluación completa y tratamiento oportuno. Aunque la incidencia específica es desconocida, análisis post mortem han mostrado que puede existir una compresión medular metastásica en 5-10% de pacientes con cáncer avanzado. La compresión de la médula espinal puede ser la manifestación inicial de una neoplasia en hasta 20% de pacientes con neoplasias malignas, en especial aquellas que debutan de manera metastásica. La neoplasia más asociada a dicha compresión es el cáncer de pulmón en 15% de los casos y mama y próstata en mujeres y hombres, respectivamente. La compresión vascular, específicamente del plexo venoso epidural, puede resultar de una lesión secundaria, causando infartos venosos y afección neurológica irreversible, al igual que aumento en la permeación vascular y generación subsecuente de edema, los cuales cuentan con diferentes mecanismos e interacciones patológicas. El objetivo del tratamiento es preservar la función nerviosa, reducir el dolor y los síntomas asociados, al igual que prevenir la discapacidad. Es de suma importancia que el tratamiento inicie en las primeras 24 horas de que se haga el diagnóstico y puede variar desde esteroides a radioterapia, cirugía y tratamiento paliativo. Por lo general, el pronóstico de una persona con compresión medular por una neoplasia maligna es pobre, oscilando entre tres y seis meses de supervivencia posterior al diagnóstico.


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