Differential Diagnosis for Sudden Onset of Paraparesis
- Single Most Likely Diagnosis
- Anterior Spinal Artery Occlusion Syndrome: This condition is characterized by the sudden onset of paraparesis or quadriparesis, loss of pain and temperature sensation, but preservation of vibration sense and proprioception. The anterior spinal artery supplies the anterior two-thirds of the spinal cord, including the corticospinal tracts and the spinothalamic tracts, which explains the loss of motor function and pain/temperature sensation.
- Other Likely Diagnoses
- Brown-Séquard Syndrome: This syndrome results from a hemisection of the spinal cord, which can be due to trauma, tumor, or ischemia. It presents with ipsilateral loss of motor function and proprioception, and contralateral loss of pain and temperature sensation. While the presentation can vary, the sudden onset of paraparesis with selective sensory loss could suggest a Brown-Séquard syndrome, especially if there's a clear lateralizing component to the deficits.
- Central Cord Syndrome: Typically presents with greater weakness in the upper limbs compared to the lower limbs, and variable sensory loss. It often occurs in the context of hyperextension injuries in patients with pre-existing cervical spondylosis. The sudden onset of paraparesis could be a variant presentation, especially if the lesion is lower in the spinal cord.
- Do Not Miss Diagnoses
- Spinal Epidural Hematoma or Abscess: These conditions can present with sudden onset of neurological deficits, including paraparesis, and require urgent intervention to prevent permanent damage. The presence of fever, back pain, or systemic signs of infection could suggest these diagnoses.
- Traumatic Spinal Cord Injury: Especially if the history suggests a recent trauma, a spinal cord injury could present with sudden onset of paraparesis and selective sensory loss, depending on the level and extent of the injury.
- Rare Diagnoses
- Intrinsic Spinal Cord Tumors: Such as astrocytomas or ependymomas, which can present with gradual or sudden onset of neurological deficits, depending on their location, size, and growth rate.
- Spinal Cord Infarction due to Aortic Dissection or Atherosclerosis: Though less common, these conditions can lead to spinal cord ischemia and infarction, presenting with sudden onset of neurological deficits, including paraparesis and sensory loss.