Differential Diagnosis

The patient presents with symptoms that started before taking Lasix, and they have a history of a severely herniated disc pressing on their S1 and S2 nerves. Here's a differential diagnosis based on the provided information:

• Single most likely diagnosis:

  • Lumbar Radiculopathy: Given the patient's history of a severely herniated disc pressing on their S1 and S2 nerves, it's likely that the symptoms are related to nerve compression. This condition can cause pain, numbness, tingling, and weakness in the lower back and legs, which aligns with the patient's complaint.

• Other Likely diagnoses:

  • Musculoskeletal Pain: The patient's symptoms could also be attributed to musculoskeletal pain, which is common in individuals with herniated discs. This pain can be exacerbated by movement, posture, or strain on the affected area.
  • Neuropathic Pain: Compression of the S1 and S2 nerves can lead to neuropathic pain, characterized by burning, shooting, or stabbing sensations in the affected areas.

• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):

  • Cauda Equina Syndrome: Although less likely, cauda equina syndrome is a serious condition that requires immediate medical attention. It occurs when the nerves in the spinal canal are compressed, leading to symptoms such as severe pain, numbness, and weakness in the legs, as well as bladder and bowel dysfunction.
  • Spinal Infection or Abscess: Infections or abscesses in the spine can cause severe pain, numbness, and weakness, and can be life-threatening if left untreated.

• Rare diagnoses:

  • Tarlov Cyst: A rare condition where fluid-filled cysts form on the nerve roots, which can cause pain, numbness, and weakness in the affected areas.
  • Arachnoiditis: Inflammation of the membranes surrounding the spinal cord, which can cause pain, numbness, and weakness in the lower back and legs.