Differential Diagnosis for Positive Leg Raise Test with Lumbar Pain, Vertigo, and Blood Pressure Changes
- Single Most Likely Diagnosis
- Lumbar Disc Herniation with Autonomic Nervous System Involvement: This condition could explain the lumbar pain and vertigo due to compression or irritation of nerve roots that also affect autonomic functions, leading to blood pressure changes. The positive leg raise test is often indicative of lumbar disc herniation.
- Other Likely Diagnoses
- Spinal Stenosis: This condition can cause lumbar pain and may lead to vertigo and blood pressure changes if the stenosis affects the spinal cord or nerve roots that influence autonomic functions. The leg raise test can exacerbate symptoms by further compressing the affected area.
- Spondylolisthesis: Similar to spinal stenosis, spondylolisthesis can cause lumbar pain and, if severe, may affect autonomic functions leading to vertigo and blood pressure changes. The positive leg raise test could indicate nerve root irritation.
- Do Not Miss Diagnoses
- Cauda Equina Syndrome: Although less common, this is a medical emergency that requires immediate attention. It can cause lumbar pain, vertigo (due to autonomic dysfunction), and blood pressure changes. A positive leg raise test could indicate significant nerve root compression.
- Spinal Epidural Abscess: This condition is a medical emergency that can cause severe back pain, neurological deficits, and systemic symptoms including vertigo and blood pressure instability due to autonomic nervous system involvement.
- Rare Diagnoses
- Arteriovenous Malformation (AVM) of the Spine: AVMs can cause a variety of symptoms including back pain, neurological deficits, and systemic symptoms due to shunting and potential effects on the autonomic nervous system.
- Spinal Cord Infarction: Although rare, spinal cord infarction can present with sudden onset of back pain, neurological deficits, and potentially vertigo and blood pressure changes if the infarction affects areas involved in autonomic control.