Differential Diagnosis
- Single most likely diagnosis
- E) Transverse myelitis: This condition is characterized by inflammation across a segment of the spinal cord, which can cause progressive sensory loss, urinary symptoms, and a band-like sensation around the abdomen. The patient's symptoms, including ascending sensory loss to the umbilicus, urinary urgency and frequency, and a tight band-like sensation, are consistent with this diagnosis. The examination findings of slowed eye adduction and diffuse hyperreflexia also support this diagnosis.
- Other Likely diagnoses
- D) Spinal cord compression: This condition can cause similar symptoms to transverse myelitis, including progressive sensory loss and urinary symptoms. However, spinal cord compression is typically caused by a mass or lesion compressing the spinal cord, which may not be present in this patient.
- B) Polyradiculopathy: This condition involves inflammation of multiple nerve roots, which can cause sensory loss and urinary symptoms. However, polyradiculopathy typically presents with more widespread and asymmetric symptoms.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- D) Spinal cord compression: Although this diagnosis may not be as likely as transverse myelitis, it is crucial to consider and rule out spinal cord compression, as it can be a medical emergency requiring prompt intervention.
- A) Anterior cerebral artery occlusion: Although this diagnosis is unlikely, given the patient's symptoms and examination findings, it is essential to consider and rule out any potential vascular causes, as they can be life-threatening.
- Rare diagnoses
- C) Sensorimotor peripheral neuropathy: This condition involves damage to the peripheral nerves, which can cause sensory loss and other symptoms. However, the patient's symptoms and examination findings are not typical of a peripheral neuropathy, making this diagnosis less likely.
- Other rare conditions, such as multiple sclerosis or neuromyelitis optica, could also be considered, but they are less likely given the patient's presentation and lack of other symptoms.