Differential Diagnosis for 40-year-old with SLE, ACDF, and Neurological Symptoms
Single Most Likely Diagnosis
- Cervical Spine Instability or Pseudoarthrosis: Given the patient's history of Anterior Cervical Discectomy and Fusion (ACDF), a complication related to the surgery such as instability or pseudoarthrosis could lead to neurological symptoms like left lower extremity weakness and numbness due to compression or irritation of the spinal cord or nerve roots.
Other Likely Diagnoses
- Systemic Lupus Erythematosus (SLE) Flare: SLE can cause a wide range of neurological symptoms, including headaches, weakness, and numbness, due to its effects on the central nervous system. A flare of the disease could explain the patient's symptoms.
- Cervical Disc Herniation: A new or recurrent disc herniation at a level adjacent to the previous ACDF site could compress nerve roots or the spinal cord, leading to the patient's symptoms.
- Spinal Stenosis: Narrowing of the spinal canal, which could be congenital or acquired, might be exacerbated by the previous surgery, leading to symptoms of spinal stenosis such as weakness, numbness, and headaches.
Do Not Miss Diagnoses
- Spinal Epidural Hematoma: Although rare, a spinal epidural hematoma is a medical emergency that requires immediate attention. It could occur spontaneously or as a complication of the ACDF surgery and would present with sudden onset of neurological deficits.
- Infection (Osteomyelitis or Discitis): Post-surgical infection is a serious complication that could lead to neurological symptoms due to compression or destruction of spinal structures.
- Cerebral Vasculitis: As a complication of SLE, cerebral vasculitis could present with headaches and neurological deficits, including weakness and numbness.
Rare Diagnoses
- Neurosarcoidosis: Sarcoidosis affecting the central nervous system could present with a variety of neurological symptoms, including weakness, numbness, and headaches, although it is less common.
- Multiple Sclerosis: An autoimmune disease that affects the brain and spinal cord, leading to a wide range of neurological symptoms. While possible, it would be less likely given the patient's history of SLE and ACDF.
- Spinal Arteriovenous Malformation (AVM): A rare vascular anomaly that could cause neurological symptoms due to compression or steal phenomenon affecting the spinal cord.