Spinal Cord Disorders - Differential Diagnosis Framework



Spinal cord neurological lesion:

Clinical findings:

 • Symptoms and signs below the site of a lesion.



Corticospinal Tract Lesions:

 • Bilateral findings of:

	- Spastic paresis/paralysis

	- Weakness

	- Hyperreflexia

	- Muscle spasticity

	- Extensor plantar responses

	- Loss of sensation at or below the site of injury

	- Loss of bowel/bladder continence

 • Pain reported at level of spinal cord compression

 • Disruption of bladder bladder continence

 • Disruption of sensation at or below the site of injury

 • Gait is abnormal often- Sensory ataxia or spasticity

 • Lower roots -> Cauda equina- decreased muscle tone, areflexia, loss of perianal sensation



Compression of the spinal cord:

 • Herniated disc

 • Epidural abscess

 • Epidural hemorrhage

 • Cervical spondylosis

 • Epidural, intradural or intermedullary neoplasm

 • Posttraumatic compression by fractured vertebral body



Non-compressive Spinal Cord Causes:

1. Demyelinating:

	- Multiple sclerosis

	- Transverse myelitis

	- Neuromyelitis optica

	- Sarcoidosis

	- Radiation myelopathy

	- Spinal injuries

2. Infections:

	- Viral: VZV, HSV, HIV, CMV, HTLV

	- Mycoplasma, Influenza, EBV, Dengue, Measles, Mumps, WNV

	- Parasite: Schistosomiasis Toxoplasmosis, Neurocysticercosis

	- Bacterial: Borrelia, Treponema, Listeria, TB

	- Spinal abscess: hematogenous spread

	- Fungal: Actinomyces, Blastomyces dermatitidis, Coccidioides, Aspergillus

3. Vascular/Blockage of the Blood Supply:

	- AVM

	- Antiphospholipid and other hypercoagulable states

	- Hemorrhage

	- Ant. Spinal artery thrombosis

4. Toxic Metabolic:

	- Chemotherapy

	- Radiation myelopathy

	- Vit B12 and copper levels

5. Inflammatory:

	- Sarcoidosis, Behcet disease

	- SLE, Scleroderma, Systemic sclerosis

	- MCTD, Sjogren syndrome



Cord Compression Symptoms:

 • Back pain

 • Weakness

 • Sensory loss: Sensory level (1-5 levels below lesion)

 • Bowel and bladder dysfunction

 • Abnormal reflexes: Areflexia



UMN Symptoms: 

 • Upper extremity, lower extremity and/or bulbar region

 • Weakness + slowness

 • Hyperreflexia

 • Spasticity

 • Extensor plantar response



LMN Symptoms:

 • Weakness

 • Loss of muscle (atrophy)

 • Muscle twitching (fasciculations)



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