Spinal cord compression differential diagnosis
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Overview
Differentiating Spinal Cord Compression from other Diseases
Acute spinal cord compression presents to ER with sudden onset of paralysis along with back pain, it must be differentiated from other diseases with similar presentation such as muscle weakness and back pain. Transverse myelitis, GBS(Guillian-Barrie syndrome), HIV-myopathy, diabetic neuropathy, multiple sclerosis(MS), amyotrophic lateral sclerosis(ALS) and peripheral neuropathies are some of the diseases to be considered in the differential. The following table describes the differentiating signs and symptoms of other diseases from a acute spinal cord compression.
Disease/Condition | Differentiating Signs/Symptoms | Differentiating Tests | |
---|---|---|---|
CSF Findings | Other diagnostic tests | ||
Transverse myelitis | Febrile illness preceding the symptoms
LE >UE |
Pleocytosis
↑Total protein |
Focal demyelination on MRI |
Guillain-Barre syndrome (GBS) | History of gastroenteritis or influenza-like illness
Ascending paralysis Loss of deep tendon reflexes Respiratory muscle weakness requiring ventilation |
Albumin-cytologic dissociation
↑Total protein |
EMG shows decreased conduction
Seropositive for Campylobacter jejuni (50% cases) |
HIV-related myelopathy | History of HIV infection
Paraparesis, spasticity or ataxia (or both) coupled with dementia |
Nonspecific | ELISA + followed by confirmation with Westeren blot. |
Amyotrophic lateral sclerosis (ALS) | Combination of UMN and LMN
Muscle weakness and stiffness as the initial symptoms |
Nonspecific | Fibrillation potentials and positive sharp waves, with fasciculation potentials on EMG |
Multiple sclerosis | Mimic clinical symptoms of spinal, compression, however, all cases involve the brain.
Presents with multiple episodes separated by space with self-resolution Visual symptom (neuromyelitis optica) distinct for MS |
↑ IgG and oligobands | MRI brain shows areas of demyelination. |
Diabetic neuropathy | History of diabetes mellitus.
Pain and loss of sensation in the feet in a glove-and-stocking distribution. Bladder dysfunction may be present due to autonomic neuropathy. |
Nonspecific | EMG shows reduction in sensory nerve conduction and a decrease in amplitude. |
Polymyositis | Symmetrical weakness of shoulder and pelvic girdles. | Nonspecific | EMG include spontaneous fibrillations, low-amplitude short-duration polyphasic motor potentials
Muscle biopsy shows immune cell infiltration and destruction of muscle fibers |
Hereditary muscular dystrophy | Proximal and distal muscle weakness
Without sensory changes in the initial stages. |
Nonspecific | MRI and EMG/nerve conduction studies will show only myopathic changes |