Differential Diagnosis for Bilateral Upper and Lower Limb Weakness, Back, and Neck Pain

Single Most Likely Diagnosis

• Degenerative Disc Disease or Cervical/Lumbar Spondylosis: This condition is a common cause of bilateral limb weakness, back, and neck pain due to the compression of spinal nerves. It is often seen in older adults and can be attributed to the wear and tear of the spinal discs and joints.

Other Likely Diagnoses

• Multiple Sclerosis: An autoimmune disease that affects the brain and spinal cord, leading to a wide range of neurological symptoms, including limb weakness, pain, and sensory disturbances.
• Spinal Stenosis: Narrowing of the spinal canal, which can compress the spinal cord or nerves, causing pain, weakness, and numbness in the limbs.
• Radiculopathy: Damage or irritation of the nerve roots, which can cause pain, weakness, and numbness in the limbs.
• Peripheral Neuropathy: Damage to the peripheral nerves, which can cause weakness, numbness, and pain in the limbs.

Do Not Miss Diagnoses

• Spinal Cord Compression: A medical emergency that requires immediate attention, caused by compression of the spinal cord, which can lead to permanent neurological damage if not treated promptly.
• Guillain-Barré Syndrome: A rare autoimmune disorder that can cause rapid onset of muscle weakness, often starting in the lower limbs and ascending to the upper limbs, which can be life-threatening if not recognized and treated early.
• Cauda Equina Syndrome: A condition caused by compression of the nerves in the lower spine, leading to severe pain, weakness, and loss of bladder and bowel control, requiring urgent medical attention.
• Meningitis or Encephalitis: Infections of the meninges or brain, which can present with limb weakness, pain, and other neurological symptoms, and are medical emergencies.

Rare Diagnoses

• Amyotrophic Lateral Sclerosis (ALS): A progressive neurological disease that affects nerve cells in the brain and spinal cord, causing loss of muscle control.
• Muscular Dystrophy: A group of inherited disorders characterized by progressive muscle weakness and degeneration.
• Neurosyphilis: A complication of untreated syphilis infection, which can cause a range of neurological symptoms, including limb weakness and pain.
• Vitamin B12 Deficiency: A condition that can cause neurological symptoms, including limb weakness, numbness, and gait disturbances, due to the importance of vitamin B12 in the synthesis of myelin.