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Differential Diagnosis for Myelopathy

Single most likely diagnosis

  • Arteriovenous Malformation (AVM) or Dural Arteriovenous Fistula (DAVF): These conditions can cause myelopathy that worsens with heat due to increased blood flow, and a painful soft tissue palpable thrill over the thoracic region could be indicative of an abnormal vascular structure.

Other Likely diagnoses

  • Spinal Dural Artery Malformation: Similar to AVM or DAVF, this condition involves abnormal blood vessels that can cause myelopathy and may worsen with heat.
  • Spinal Arteriovenous Malformation (Type II): A specific type of spinal AVM that can cause progressive myelopathy and may have a palpable thrill.
  • Cervicothoracic Syringomyelia: While not directly related to vascular abnormalities, syringomyelia can cause myelopathy and may worsen with heat; a palpable thrill could be related to an associated vascular malformation.

Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)

  • Spinal Epidural Abscess: An infectious process that can cause myelopathy and may worsen with heat due to increased metabolic activity; a palpable thrill could be related to an associated vascular phenomenon or abscess pulsation.
  • Malignant Spinal Tumor: Certain tumors, such as those with high vascularity, could potentially cause a palpable thrill and myelopathy that worsens with heat due to increased tumor activity.

Rare diagnoses

  • Spinal Hemangioma with Arteriovenous Shunting: A rare vascular tumor that could cause myelopathy and a palpable thrill, potentially worsening with heat.
  • Spinal Arteritis or Vasculitis: Inflammatory conditions affecting the spinal arteries, which could cause myelopathy and potentially worsen with heat; a palpable thrill could be related to vascular inflammation.

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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