Differential Diagnosis of Acute and Chronic Paraplegia

The differential diagnosis for acute and chronic paraplegia is broad and includes various conditions that affect the spinal cord, nerves, and muscles. Here's a categorized list of potential diagnoses:

• Single Most Likely Diagnosis
  • Traumatic spinal cord injury: This is often the most common cause of acute paraplegia, resulting from accidents, falls, or sports injuries that damage the spinal cord.
• Other Likely Diagnoses
  • Spinal cord compression due to tumor or metastasis: Tumors, either primary or metastatic, can compress the spinal cord, leading to paraplegia.
  • Spinal stenosis: Narrowing of the spinal canal can compress the spinal cord, especially in the cervical and lumbar regions.
  • Multiple sclerosis: An autoimmune disease that affects the central nervous system, leading to demyelination and neurological deficits, including paraplegia.
  • Guillain-Barré syndrome: An autoimmune disorder that causes rapid-onset muscle weakness and paralysis, often following an infection.
• Do Not Miss Diagnoses
  • Spinal epidural abscess: A serious infection that can compress the spinal cord, leading to paralysis and potentially life-threatening if not promptly treated.
  • Spinal cord infarction: A stroke that affects the spinal cord, which can result in acute paraplegia and requires immediate medical attention.
  • Cauda equina syndrome: A condition caused by compression of the nerve roots in the lumbar spine, leading to neurological deficits, including paralysis and loss of bladder and bowel control.
• Rare Diagnoses
  • Transverse myelitis: An inflammation of the spinal cord that can cause paraplegia, often of unknown cause but can be associated with infections or autoimmune diseases.
  • Arachnoiditis: Inflammation of the arachnoid membrane surrounding the spinal cord, which can lead to scarring and compression of the spinal cord.
  • Neurosyphilis: A complication of untreated syphilis that can affect the spinal cord, leading to paraplegia among other neurological symptoms.
  • Vitamin B12 deficiency: A nutritional deficiency that can cause subacute combined degeneration of the spinal cord, leading to paraplegia and other neurological deficits.

Each of these diagnoses has a distinct set of clinical features, diagnostic tests, and treatment approaches. A thorough medical history, physical examination, and appropriate diagnostic tests are crucial for determining the underlying cause of paraplegia.