Differential Diagnosis for UMN Spine Lesion
Given the patient's symptoms, including positive Babinski, heavy legs feeling, intentional tremor of hands, weakness of fingers, some vision, and full body muscle tics, without lesions in the brain, C1, C2, C3, or C4, the following differential diagnosis is considered:
Single Most Likely Diagnosis
- C5-C6 spinal cord lesion: This level of lesion could explain the upper motor neuron (UMN) signs such as positive Babinski, weakness of fingers, and heavy legs feeling due to the involvement of the corticospinal tracts. Intentional tremor of hands could be related to the disruption of cerebellar pathways that might be affected at this level. The presence of full body muscle tics could be indicative of a more complex neurological issue but could potentially be related to the spinal lesion affecting various neural pathways.
Other Likely Diagnoses
- C7-T1 spinal cord lesion: A lesion at this level could also result in UMN signs, including weakness and tremor, though the pattern of weakness might be slightly different, potentially affecting the hands more than the legs. The involvement of the lower cervical and upper thoracic spinal cord could lead to a variety of sensory and motor disturbances.
- Thoracic spinal cord lesion (T2-T12): Lesions in the thoracic spine could lead to UMN signs below the level of the lesion, including weakness, spasticity, and sensory disturbances. However, the presence of intentional tremor and full body muscle tics might be less typical for a thoracic lesion, which more commonly presents with sensory levels and autonomic dysfunction.
Do Not Miss Diagnoses
- Multiple sclerosis (MS): Although MS typically presents with more disseminated lesions in time and space, a single large lesion in the spinal cord (tumefactive demyelination) could mimic a structural lesion. MS could explain the wide range of neurological symptoms, including vision problems, muscle tics, and both UMN and possible lower motor neuron signs.
- Spinal cord infarction: An infarct in the spinal cord, possibly due to aortic disease, vasculitis, or other vascular issues, could present acutely with a combination of UMN and lower motor neuron signs, depending on the areas of the spinal cord affected.
Rare Diagnoses
- Subacute combined degeneration (vitamin B12 deficiency): This condition affects the dorsal columns and corticospinal tracts, leading to UMN signs, sensory ataxia, and potentially vision problems. However, the presence of full body muscle tics and intentional tremor would be unusual.
- Intramedullary spinal cord tumors: Tumors such as ependymomas or astrocytomas within the spinal cord could cause a variety of neurological symptoms depending on their location and the pathways they compress or invade. The symptoms could include UMN signs, sensory disturbances, and potentially complex motor phenomena like muscle tics.