Differential Diagnosis
The patient's symptoms of sudden weakness in both legs and inability to urinate, along with decreased sensation to pinprick bilaterally, suggest a spinal cord lesion. Here's a categorized differential diagnosis:
- Single most likely diagnosis
- Spinal cord infarction: This is the most likely diagnosis given the sudden onset of bilateral leg weakness and urinary retention. Spinal cord infarction can result from a variety of causes, including atherosclerosis, embolism, or venous thrombosis, and can present with rapid progression of symptoms.
- Other Likely diagnoses
- Spinal cord tumor: Although less likely given the sudden onset, a spinal cord tumor could cause similar symptoms if it were to suddenly compress the spinal cord or cause a spinal cord infarction.
- Guillain-Barré syndrome: This is an autoimmune disorder that can cause ascending paralysis, but it typically starts in the lower extremities and ascends, and may not initially present with urinary retention.
- Do Not Miss
- Spinal epidural abscess or hematoma: These conditions can cause rapid neurological deterioration and require urgent surgical intervention. Although less likely, they could present with similar symptoms and would be catastrophic if missed.
- Cauda equina syndrome: This is a condition caused by compression of the nerve roots in the lumbar spine, which can present with urinary retention, leg weakness, and decreased sensation. It requires urgent evaluation and treatment.
- Rare diagnoses
- Syringomyelia: This is a rare condition characterized by a fluid-filled cavity within the spinal cord, which can cause bilateral loss of pain and temperature sensation, but it typically has a more gradual onset.
- Cervical radiculopathy: This is unlikely given the bilateral nature of the symptoms and the presence of urinary retention, which suggests a more central lesion.