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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