Differential Diagnosis for Sudden Onset of Paraparesis
- Single most likely diagnosis
- Anterior Spinal (Artery Occlusion) Cord Syndrome: This condition is characterized by the sudden onset of paraparesis or paraplegia, 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 mediate pain and temperature sensation. Occlusion of this artery can lead to the described clinical presentation.
- Other Likely diagnoses
- Central Cord Syndrome: Typically presents with greater weakness in the upper limbs compared to the lower limbs, but can also involve loss of pain and temperature sensation. However, the classic presentation includes preserved vibration and proprioception, similar to the case described.
- Brown-Séquard Syndrome: Results from a hemisection of the spinal cord, leading to ipsilateral weakness and loss of vibration and proprioception, with contralateral loss of pain and temperature sensation. While it's a possible consideration, the described loss of pain and temperature with intact vibration sense across the board doesn't perfectly align with the typical presentation of Brown-Séquard Syndrome.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Spinal Epidural Abscess or Hematoma: These conditions can compress the spinal cord and present with sudden onset of neurological deficits, including paraparesis and loss of sensation. Prompt diagnosis and treatment are crucial to prevent permanent damage.
- Traumatic Spinal Cord Injury: Especially if the onset of symptoms was preceded by trauma, a spinal cord injury could present with similar symptoms and requires immediate attention.
- Rare diagnoses
- Posterior Spinal (Artery Occlusion) Cord Syndrome: This is less common and typically involves the dorsal columns, leading to loss of vibration and proprioception, which is not the primary presentation in this case.
- Intrinsic Spinal Cord Tumors or Cysts: While rare, these can cause a variety of neurological deficits depending on their location within the spinal cord. The sudden onset described would be unusual for these conditions, but they should be considered in the differential diagnosis, especially if other causes are ruled out.