Differential Diagnosis for 74-year-old Male with Leg Pain
Single most likely diagnosis
- Lumbar Spinal Stenosis: This condition is characterized by narrowing of the spinal canal, which can cause pain, numbness, and weakness in the legs. The pain typically starts in the buttock and radiates down to the ankle, worsening with standing and walking, and improving with sitting or lying down. The patient's age and symptoms are consistent with this diagnosis.
Other Likely diagnoses
- Lumbar Disc Herniation: A herniated disc in the lumbar spine can cause pain that radiates down to the ankle, especially if the disc is compressing a nerve root. The pain may worsen with standing and walking, and improve with sitting or lying down.
- Degenerative Spondylolisthesis: This condition occurs when a vertebra in the lumbar spine slips out of place, which can cause pain and stiffness in the lower back, buttock, and leg.
- Piriformis Syndrome: The piriformis muscle runs from the base of the spine to the thighbone, and can compress the sciatic nerve, causing pain that radiates down to the ankle.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Cauda Equina Syndrome: This is a rare but serious condition that occurs when the nerves in the spinal canal are compressed, causing pain, numbness, and weakness in the legs, as well as bowel and bladder dysfunction. If left untreated, it can lead to permanent damage.
- Abdominal Aortic Aneurysm: Although less likely, an abdominal aortic aneurysm can cause back and leg pain, especially if it is compressing nearby nerves or structures.
- Spinal Epidural Abscess: A rare but potentially life-threatening condition that occurs when an abscess forms in the spinal canal, causing pain, fever, and neurological symptoms.
Rare diagnoses
- Neurogenic Claudication: A rare condition that causes pain and weakness in the legs, especially when walking, due to compression of the spinal nerves.
- Chronic Inflammatory Demyelinating Polyneuropathy (CIDP): A rare autoimmune disorder that causes nerve damage and can lead to pain, numbness, and weakness in the legs.
- Tumors (e.g. spinal, pelvic, or soft tissue): Although rare, tumors can cause pain and neurological symptoms in the legs, and should be considered in the differential diagnosis.