Differential Diagnosis for Sudden Bilateral Hamstring Spasticity
- The following differential diagnosis is organized into categories to guide the thought process and identify the most likely causes.
Single Most Likely Diagnosis
- Cerebral Vasospectomy or Stroke: Sudden onset bilateral hamstring spasticity could be indicative of a stroke or cerebral vasospasm affecting the motor control areas of the brain, particularly those responsible for lower limb movement. This would lead to increased muscle tone and spasticity.
Other Likely Diagnoses
- Spinal Cord Injury or Cervical Spondylitis: Injury to the spinal cord or cervical spondylitis could compress or damage the spinal cord, leading to bilateral spasticity in the hamstrings due to the disruption of normal spinal cord function.
- Intracranial Hypertension: Increased pressure within the skull can cause a variety of neurological symptoms, including spasticity, due to the pressure exerted on the brain and its motor control pathways.
- Infections (Meningitis, Encephalitis): Certain infections affecting the central nervous system can cause inflammation that leads to increased muscle tone and spasticity.
Do Not Miss Diagnoses
- Cervernocebral Vasculitis: Although less common, vasculitis affecting the cerebral vessels can lead to sudden neurological deficits, including spasticity. Missing this diagnosis could lead to severe consequences due to the potential for further vascular damage.
- Spinal Cord Tumor or Cyst: A tumor or cyst compressing the spinal cord could cause sudden onset of bilateral spasticity. Early diagnosis is crucial for effective treatment and prevention of further neurological deterioration.
- Intracranial Hemorrhage: Bleeding within the brain can cause sudden increases in intracranial pressure, leading to spasticity among other symptoms. Prompt recognition and treatment are essential to prevent further damage.
Rare Diagnoses
- Guillian-Barré Syndrome: An autoimmune disorder that can cause rapid onset muscle weakness and, in some cases, spasticity, though it more commonly presents with flaccid paralysis initially.
- Acute Transverse Myelitis: Inflammation of the spinal cord that can cause a range of neurological symptoms, including spasticity, due to the disruption of spinal cord function.
- Neoplastic or Paraneoplastic Syndromes: Certain cancers can cause neurological symptoms, including spasticity, either directly through metastasis or indirectly through paraneoplastic syndromes. These are rare but important considerations in the differential diagnosis.