A 67-year-old man with a history of metastatic prostate cancer and known thoracic spinal cord compression presents to the emergency department with acute onset paraplegia and urinary retention. His wife reports he was started on doxazosin 4 mg daily yesterday for lower urinary tract symptoms. Current vital signs are BP 78/45 mmHg, HR 112/min, RR 22/min, temperature 37.2°C, and SpO2 97% on room air. Physical examination reveals bilateral lower extremity weakness (3/5) with preserved sensory function. MRI of the thoracic spine shows no interval change in the size of the known cord compression compared to imaging 2 months prior. Laboratory values include hemoglobin 7.9 g/dL, creatinine 1.6 mg/dL, and normal lumbar puncture studies. Which of the following mechanisms best explains this patient's acute neurologic deterioration?

1. A)Direct doxazosin-induced axonal demyelination via disruption of myelin protein synthesis
2. B)Acute spinal cord ischemia secondary to doxazosin-induced systemic hypotensionGABARITO
3. C)Hemorrhagic transformation of the preexisting spinal cord lesion due to increased intracranial pressure
4. D)Allergic hypersensitivity reaction with vasculitis affecting spinal cord vasculature
5. E)Neoplastic progression with acute epidural metastatic disease causing cord compression