Differential Diagnosis for Lower Extremity Weakness, Sensory Deficits, and Wide-Based Gait

Single Most Likely Diagnosis

• Cervical Spondylotic Myelopathy (CSM): This condition is a common cause of lower extremity weakness, sensory deficits, and gait disturbances in adults, particularly those over 50. The wide-based gait is often seen due to proprioception loss and spinal cord compression.

Other Likely Diagnoses

• Lumbar Stenosis: This condition can cause neurogenic claudication, leading to lower extremity weakness, sensory deficits, and gait difficulties, especially after walking. Symptoms are often relieved by bending forward or sitting.
• Peripheral Neuropathy: Conditions like diabetic neuropathy can cause sensory deficits and weakness in the lower extremities, although a wide-based gait is less common.
• Multiple Sclerosis: This demyelinating disease can present with a wide range of neurological symptoms, including lower extremity weakness, sensory deficits, and ataxia leading to a wide-based gait.

Do Not Miss Diagnoses

• Spinal Epidural Abscess: A medical emergency that can cause rapid progression of neurological deficits, including lower extremity weakness and sensory loss. Prompt diagnosis and treatment are crucial to prevent permanent damage.
• Spinal Cord Infarction: Although rare, spinal cord infarction can present with sudden onset of lower extremity weakness, sensory deficits, and loss of reflexes, making it a critical diagnosis not to miss.
• Cauda Equina Syndrome: A condition that requires urgent surgical intervention, characterized by low back pain, bilateral sciatica, sensory disturbances in the lower limbs, and potentially bladder and bowel dysfunction.

Rare Diagnoses

• Subacute Combined Degeneration (Vitamin B12 Deficiency): A condition that affects the spinal cord, leading to weakness, sensory deficits, and ataxia. It's rare but important to consider, especially in patients with risk factors for vitamin B12 deficiency.
• Tabes Dorsalis (Neurosyphilis): A late manifestation of syphilis that can cause sensory ataxia, leading to a wide-based gait, along with other neurological symptoms. It's now rare in many parts of the world due to effective screening and treatment of syphilis.
• Adrenoleukodystrophy: A genetic disorder that can cause progressive damage to the spinal cord, leading to lower extremity weakness and sensory deficits, among other symptoms. It's rare and primarily affects males.