Differential Diagnosis for One Foot Colder than the Other after Spinal Surgery in a Non-Ambulatory Cerebral Palsy Patient

• Single Most Likely Diagnosis
  • Deep Vein Thrombosis (DVT): This is a common complication in non-ambulatory patients, especially after surgery. The difference in temperature between the two feet could indicate impaired blood flow to one leg, which is a symptom of DVT.
• Other Likely Diagnoses
  • Compartment Syndrome: Although less common in non-ambulatory patients, compartment syndrome can occur after surgery, especially if there was significant tissue injury or if the patient has been in the same position for an extended period. It can cause decreased blood flow to the affected limb, leading to temperature differences.
  • Arterial Thrombosis or Embolism: Similar to DVT, arterial thrombosis or embolism can cause a sudden decrease in blood flow to one limb, resulting in temperature differences. This is less common than DVT but still a possibility, especially in patients with risk factors for thrombosis.
  • Pressure Ulcer or Skin Breakdown: Non-ambulatory patients are at high risk for pressure ulcers, which can cause localized changes in skin temperature due to inflammation and tissue damage.
• Do Not Miss Diagnoses
  • Pulmonary Embolism (PE) with associated DVT: While PE itself may not directly cause one foot to be colder, it is a potentially life-threatening complication of DVT. Missing a diagnosis of PE could be fatal.
  • Aortic Dissection: Although rare, an aortic dissection could potentially cause unequal blood flow to the lower extremities, leading to temperature differences. This is a medical emergency that requires immediate attention.
  • Spinal Cord Injury or Ischemia: Complications from spinal surgery could result in spinal cord injury or ischemia, affecting blood flow and temperature regulation in the lower extremities. This would be a catastrophic outcome if missed.
• Rare Diagnoses
  • Vasculitis: Inflammatory diseases affecting blood vessels could potentially cause unequal blood flow to the lower extremities, leading to temperature differences. However, this would be an uncommon cause in the context of recent spinal surgery.
  • Complex Regional Pain Syndrome (CRPS): This condition can cause significant changes in skin temperature, among other symptoms, but it is relatively rare and typically presents with more widespread pain and sensory changes.