Differential Diagnosis for Bilateral Upper Extremity and Lower Thigh Weakness
Single Most Likely Diagnosis
- Spinal Epidural Hematoma: This condition is a strong consideration given the recent history of a shoulder procedure, which could have led to bleeding into the spinal epidural space. The presentation of bilateral upper extremity weakness and lower thigh weakness without calf involvement suggests a cervical or upper thoracic spinal cord lesion, which could be consistent with an epidural hematoma.
Other Likely Diagnoses
- Spinal Cord Infarction: Although less common, spinal cord infarction could present with acute weakness. The pattern of weakness could suggest an infarct in the spinal cord, possibly related to atherosclerosis given the patient's history of hypercholesterolemia.
- Postoperative Neuropathy: Direct nerve injury or compression during the shoulder procedure could lead to neuropathy, manifesting as weakness in the affected limbs. However, the bilateral and specific pattern of weakness might make this less likely.
- Myasthenia Gravis: An autoimmune disorder that could cause fluctuating muscle weakness, which worsens with activity and improves with rest. However, the acute onset post-surgery and the specific pattern of weakness might not be typical for myasthenia gravis.
Do Not Miss Diagnoses
- Spinal Cord Compression: Due to any cause (e.g., metastasis, abscess, hematoma) could present similarly and requires immediate attention to prevent permanent neurological damage.
- Guillain-Barré Syndrome: An autoimmune disorder that can cause rapid-onset muscle weakness, often following an infection or, less commonly, surgery. It's crucial to consider this diagnosis due to its potential for respiratory compromise.
- Stroke: Although the pattern of weakness is not typical for a stroke, it's essential to rule out a cerebral cause, especially given the patient's history of hypercholesterolemia, which increases the risk of cerebrovascular disease.
Rare Diagnoses
- Acute Transverse Myelitis: An inflammatory condition affecting the spinal cord, which could present with rapid onset of weakness, sensory loss, and autonomic dysfunction. It's less likely but should be considered in the differential diagnosis.
- Neuromuscular Junction Disorders (e.g., Botulism, Lambert-Eaton Myasthenic Syndrome): These conditions could cause muscle weakness but are less common and might not fit perfectly with the postoperative context and the specific pattern of weakness described.