Differential Diagnosis for Left Lower Limb Weakness
- Single most likely diagnosis
- Transverse Myelitis: Given the acute onset of left lower limb weakness, inability to turn from bed, abdominal pain, and history of fever, along with MRI findings of hyperintensity from D6 to D10 in the lateral and dorsal cord, transverse myelitis is a strong consideration. The condition is characterized by inflammation across a segment of the spinal cord, which can result from various causes including post-infectious, autoimmune, or idiopathic origins.
- Other Likely diagnoses
- Multiple Sclerosis (MS): Although less likely given the acute presentation and specific MRI findings, MS could be considered, especially with a history of previous episodes of radicular pain. However, the lack of disseminated lesions in time and space (a hallmark of MS) makes this less probable.
- Spinal Cord Infarction: This could present with acute weakness and might be considered, especially if there were any vascular risk factors or a history suggestive of a vascular event. However, the MRI findings and the clinical presentation would need to align more closely with an infarct pattern.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Spinal Epidural Abscess: Although less common, this condition is a medical emergency that requires prompt diagnosis and treatment. The history of fever and back pain, along with neurological deficits, makes this a critical diagnosis not to miss.
- Spinal Cord Compression: Due to tumor, hematoma, or other causes, this is another emergency that could present with acute neurological decline. The history of hyperthyroidism and previous episodes of radicular pain might suggest a predisposition to osteoporosis or other bone diseases, increasing the risk of compression fractures.
- Rare diagnoses
- Neuromyelitis Optica Spectrum Disorder (NMOSD): This is an autoimmune condition that predominantly affects the optic nerve and spinal cord. While it could present with myelitis, the specific pattern of involvement and the presence of optic neuritis (not mentioned) would be more typical.
- Sarcoidosis: This systemic disease can affect the spinal cord, among other organs, and could present with myelopathy. However, other systemic symptoms or findings suggestive of sarcoidosis would typically be present.