Differential Diagnosis for Acute Paraplegia with Sensory Loss

Single Most Likely Diagnosis

• Guillain-Barré Syndrome (GBS): Given the acute onset of paraplegia, sensory loss, elevated CSF protein (458), and the presence of neutrophilic predominance, GBS is a strong consideration. The condition is characterized by an immune-mediated attack on the peripheral nerves, leading to rapid progression of muscle weakness and areflexia. The elevated CSF protein with relatively few cells (albuminocytological dissociation) is a hallmark of GBS, although the presence of neutrophilic predominance is less typical and might suggest an alternative or complicating diagnosis.

Other Likely Diagnoses

• Transverse Myelitis: This condition involves inflammation across a segment of the spinal cord, which can present with acute paraplegia, sensory loss, and autonomic dysfunction. The elevated CSF protein and the presence of cells could support this diagnosis, although the neutrophilic predominance is less common.
• Spinal Cord Infarction: Although less likely given the CSF findings, spinal cord infarction can present with acute onset of paraplegia and sensory loss. It is usually associated with a clear vascular risk factor or event.

Do Not Miss Diagnoses

• Spinal Epidural Abscess: This is a medical emergency that can present with acute neurological deficits, including paraplegia and sensory loss. The presence of neutrophilic predominance in the CSF and elevated protein levels could be consistent with this diagnosis. Prompt recognition and treatment are crucial to prevent permanent neurological damage.
• Meningitis: Bacterial meningitis can present with neurological deficits, although the pattern is usually more diffuse. The neutrophilic predominance in the CSF could suggest bacterial meningitis, which is a medical emergency requiring immediate treatment.

Rare Diagnoses

• Neuromyelitis Optica Spectrum Disorder (NMOSD): This autoimmune condition can cause transverse myelitis and optic neuritis. While it's less likely given the acute presentation and CSF findings, it should be considered, especially if there are recurrent episodes or optic neuritis.
• Sarcoidosis: Neurosarcoidosis can involve the spinal cord, leading to a variety of neurological symptoms, including paraplegia and sensory loss. However, the diagnosis would typically require additional supportive evidence, such as systemic symptoms of sarcoidosis or characteristic findings on imaging studies.