Differential Diagnosis for Sudden Leg Weakness and Bowel Incontinence with History of Bladder Cancer

• Single Most Likely Diagnosis
  • Metastatic spinal cord compression: This is the most likely diagnosis given the history of bladder cancer and the sudden onset of leg weakness and bowel incontinence. Bladder cancer can metastasize to the spine, causing compression of the spinal cord, which leads to neurological symptoms such as leg weakness, bowel and bladder dysfunction.
• Other Likely Diagnoses
  • Spinal metastasis from bladder cancer with epidural spinal cord compression: Similar to the single most likely diagnosis, but this specifies the mechanism of spinal cord compression.
  • Cauda equina syndrome: This condition occurs when the nerves in the spinal canal are compressed, leading to symptoms such as leg weakness, numbness, and bowel and bladder dysfunction. It can be caused by metastatic disease, including from bladder cancer.
• Do Not Miss Diagnoses
  • Spinal epidural abscess: Although less likely, this is a medical emergency that requires prompt diagnosis and treatment. An abscess in the spinal epidural space can compress the spinal cord, leading to neurological symptoms.
  • Spinal hemorrhage: Bleeding into the spinal canal can cause sudden neurological symptoms, including leg weakness and bowel incontinence. This is a rare but potentially life-threatening condition.
• Rare Diagnoses
  • Primary spinal cord tumors: Tumors that originate in the spinal cord, such as astrocytomas or ependymomas, can cause neurological symptoms. However, these are less common than metastatic disease in patients with a history of cancer.
  • Inflammatory or autoimmune conditions (e.g., transverse myelitis): These conditions can cause inflammation of the spinal cord, leading to neurological symptoms. They are less likely in the context of a history of bladder cancer but should be considered if other diagnoses are ruled out.