Differential Diagnosis for the 16-year-old Girl's Condition

• Single most likely diagnosis:
  • Central cord syndrome: This condition is the most likely diagnosis because the patient has greater weakness in her arms than in her legs, which is a hallmark of central cord syndrome. The mechanism of injury, where she fell forward and struck her chin, could have caused hyperextension of the neck, leading to this type of spinal cord injury.
• Other Likely diagnoses:
  • Anterior cord syndrome: Although less likely, anterior cord syndrome could be considered due to the loss of motor function and sensation in the arms. However, this syndrome typically involves loss of temperature and pain sensation with preservation of posterior column functions (vibration, position sense), which is not explicitly mentioned in the scenario.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
  • Brown-Séquard syndrome: While the presentation does not perfectly align with Brown-Séquard syndrome (which typically involves ipsilateral loss of motor function and proprioception with contralateral loss of pain and temperature sensation), any spinal cord injury could potentially evolve or have components of different syndromes, making it crucial not to miss.
  • Spinal shock: This is not one of the listed options but is a critical "do not miss" diagnosis. Spinal shock can present with loss of spinal cord function below the level of the injury, which could initially mimic other syndromes. It's essential to recognize and manage appropriately.
• Rare diagnoses:
  • Posterior cord syndrome: This is less likely given the clinical presentation. Posterior cord syndrome involves damage to the posterior columns of the spinal cord, leading to loss of vibration, position sense, and sometimes light touch, with preservation of motor function and other sensory modalities. The patient's symptoms do not align closely with this syndrome.