What is the diagnosis for a 61-year-old female with hypertension, severe osteoporosis, and a history of lumbar compressive fracture, who presents with worsening numbness, tingling, and weakness in the lower and upper extremities after a lumbar steroid injection?

Differential Diagnosis for 61-year-old Female with Neurological Symptoms

Single Most Likely Diagnosis

• Steroid-induced worsening of osteoporosis or steroid flare: The recent lumbar steroid injection could have exacerbated the patient's osteoporosis, leading to further compression fractures or worsening of the existing fracture, causing the neurological symptoms. The steroid injection could also have caused a flare of the patient's symptoms.

Other Likely Diagnoses

• Spinal stenosis or foraminal stenosis: The patient's severe osteoporosis and lumbar compressive fracture could be causing spinal stenosis or foraminal stenosis, leading to compression of the spinal cord or nerve roots, resulting in numbness, tingling, and weakness in the extremities.
• Epidural lipomatosis: The steroid injection could have caused an increase in epidural fat, leading to compression of the spinal cord or nerve roots, resulting in neurological symptoms.
• Infection or abscess: Although less likely, an infection or abscess could have developed at the site of the steroid injection, causing neurological symptoms.

Do Not Miss Diagnoses

• Spinal epidural hematoma: A hematoma could have formed in the spinal epidural space, causing compression of the spinal cord or nerve roots, resulting in neurological symptoms. This is a medical emergency that requires prompt attention.
• Cauda equina syndrome: The patient's symptoms could be indicative of cauda equina syndrome, a condition that requires urgent medical attention to prevent permanent neurological damage.
• Meningitis or encephalitis: Although unlikely, an infection such as meningitis or encephalitis could be causing the patient's neurological symptoms, and prompt diagnosis and treatment are crucial to prevent serious complications.

Rare Diagnoses

• Multiple myeloma: The patient's severe osteoporosis could be related to multiple myeloma, a type of blood cancer that can cause bone lesions and neurological symptoms.
• Syringomyelia: A rare condition characterized by the formation of a fluid-filled cavity within the spinal cord, which could be causing the patient's neurological symptoms.
• Vitamin B12 deficiency: A deficiency in vitamin B12 could be causing the patient's neurological symptoms, including numbness, tingling, and weakness in the extremities.