Differential Diagnosis for Sudden Onset Difficulty in Walking with MRI Findings
Single Most Likely Diagnosis
- Metastatic Bladder Cancer: Given the patient's history of urethral stricture, intermittent self-catheterization, and findings of left moderate hydronephrosis, bladder thickness of 22 mm, and many RBCs in urine routine, bladder cancer with metastasis to the spine is a highly plausible explanation. The MRI findings of abnormal signal focal lesions in multiple vertebrae and pelvic bones could represent metastatic disease.
Other Likely Diagnoses
- Multiple Myeloma: The presence of multiple focal lesions in the vertebrae, iliac bones, and sacrum with characteristic signal changes (T1 hypointense and STIR hyperintense) could suggest multiple myeloma, a primary bone malignancy. However, the patient's urinary symptoms and bladder findings might not be directly related to myeloma.
- Degenerative Spinal Disease: While not directly related to the focal lesions, the patient's lumbar spondylosis changes, degenerative disc disease, and spinal stenosis could contribute to difficulty walking, especially if there is significant neural compression.
Do Not Miss Diagnoses
- Spinal Cord Compression: Regardless of the primary cause (metastasis, myeloma, or other), spinal cord compression can lead to rapid neurological deterioration. Prompt identification and management are crucial to prevent permanent damage.
- Infection (Osteomyelitis or Discitis): Although less likely given the clinical context, infection could present with similar signal changes on MRI. Missing an infectious cause could lead to severe consequences if not treated appropriately with antibiotics.
Rare Diagnoses
- Lymphoma: While less common, lymphoma could involve the spine and present with similar imaging findings. It might also explain some of the patient's systemic symptoms if present.
- Paget's Disease: A rare bone condition that could lead to vertebral lesions, although the signal characteristics and clinical presentation might differ from what is described.
- Other Metastatic Cancers: Other primary cancers (e.g., prostate, breast, lung) could metastasize to the spine, but the clinical context provided (urinary symptoms, bladder findings) makes bladder cancer a more likely consideration.