Differential Diagnosis for Young Woman with Bilateral Upper and Lower Extremity Weakness and Numbness

Single Most Likely Diagnosis

• Multiple Sclerosis (MS): The presence of bilateral upper and lower extremity weakness and numbness, along with increased T2 signal in the cervical spine MRI without any mass lesion or compression, is highly suggestive of MS. MS is a demyelinating disease that can present with a wide range of neurological symptoms, including weakness, numbness, and sensory deficits.

Other Likely Diagnoses

• Acute Transverse Myelitis (ATM): ATM is an inflammatory condition that affects the spinal cord, leading to symptoms such as weakness, numbness, and sensory deficits. The increased T2 signal in the cervical spine MRI could be consistent with ATM.
• Neuromyelitis Optica (NMO): NMO is an autoimmune disease that primarily affects the optic nerve and spinal cord, leading to symptoms such as weakness, numbness, and vision loss. The presence of increased T2 signal in the cervical spine MRI could be consistent with NMO.
• Spinal Cord Infarction: Spinal cord infarction can present with acute onset of weakness, numbness, and sensory deficits, and can be caused by a variety of factors, including atherosclerosis, embolism, or vasculitis.

Do Not Miss Diagnoses

• Spinal Epidural Abscess: Although the MRI did not show any mass lesion or compression, a spinal epidural abscess can present with subtle findings on imaging, and can be a medical emergency if not promptly treated.
• Spinal Cord Compression due to Osteoporotic Fracture: Osteoporotic fractures can occur without significant trauma, and can lead to spinal cord compression, which can present with weakness, numbness, and sensory deficits.
• Infectious Myelitis (e.g. HIV, Lyme, Syphilis): Infectious myelitis can present with a wide range of neurological symptoms, including weakness, numbness, and sensory deficits, and can be caused by a variety of infectious agents.

Rare Diagnoses

• Adrenoleukodystrophy: A rare genetic disorder that affects the adrenal glands and spinal cord, leading to symptoms such as weakness, numbness, and sensory deficits.
• Subacute Combined Degeneration: A rare condition caused by vitamin B12 deficiency, leading to demyelination of the spinal cord and symptoms such as weakness, numbness, and sensory deficits.
• Leukodystrophies (e.g. Krabbe disease, Metachromatic Leukodystrophy): A group of rare genetic disorders that affect the growth and maintenance of myelin, leading to symptoms such as weakness, numbness, and sensory deficits.