What is the most likely diagnosis for a patient presenting with lower limb weakness, urine incontinence, difficulty walking, and a T10 sensory level?

Spinal Cord Compression

The most likely diagnosis is A - Compression of Spinal Cord, given the acute presentation of bilateral lower limb weakness, urinary incontinence, and a clearly defined T10 sensory level over 3 days. 1

Clinical Reasoning

The presence of a defined sensory level at T10 is pathognomonic for spinal cord pathology and localizes the lesion to the thoracic spinal cord itself, not to peripheral nerves or nerve roots. 1 This single finding essentially rules out peripheral nervous system disorders and points directly to a myelopathy.

Why Not Guillain-Barré Syndrome (Option B)?

• Guillain-Barré syndrome presents with ascending weakness that starts distally in the legs and progresses upward over days to weeks, causing areflexia due to peripheral nerve involvement. 2, 1
• GBS does not produce a defined sensory level - it causes a glove-and-stocking sensory pattern. 2
• The presence of a T10 sensory level excludes this diagnosis. 1
• While GBS can cause autonomic dysfunction including bladder issues, this occurs in the context of diffuse peripheral neuropathy, not localized cord pathology. 2

Why Not Transverse Myelitis (Option C)?

• Transverse myelitis typically follows a viral infection or immune-mediated process. 1
• The absence of any infectious prodrome in this patient makes structural compression more likely than an inflammatory myelopathy. 1
• While transverse myelitis could theoretically present this way, the lack of preceding infection and the acute 3-day progression favor a compressive etiology requiring urgent surgical intervention. 1

Why Not Cauda Equina Syndrome (Option D)?

• Cauda equina syndrome affects lumbosacral nerve roots below L1-L2, causing lower motor neuron signs with areflexia. 1, 3
• A T10 sensory level is anatomically too high for cauda equina syndrome - this level indicates thoracic spinal cord involvement. 1
• The cauda equina begins at approximately L1-L2, so pathology there cannot produce a T10 sensory level. 3

Critical Diagnostic Features Supporting Spinal Cord Compression

• Bilateral lower limb weakness with urinary incontinence and a defined sensory level represents the classic triad of acute myelopathy. 1
• The 3-day time course indicates an evolving compressive process requiring emergency intervention. 1
• The combination of motor, sensory, and autonomic dysfunction at a specific spinal level has high diagnostic accuracy for spinal cord pathology. 1
• Cervical cord compression can present with lower limb symptoms even without upper extremity involvement, but a T10 sensory level localizes this to thoracic cord. 4, 5

Immediate Management Required

• Obtain MRI of the entire spine without and with contrast immediately to identify the compressive lesion. 1
• Do not delay imaging - spinal cord compression requires urgent surgical decompression within hours to prevent permanent neurological deficit. 1
• Urgent neurosurgical consultation should be obtained upon clinical suspicion, as timing of decompression is critical for neurological recovery. 1
• Early surgical decompression within 24 hours is associated with better functional outcomes in compressive myelopathy. 1

Common Pitfall to Avoid

Do not be misled by the absence of back pain or trauma history - compressive myelopathy can present with pure neurological symptoms without significant pain, and the sensory level is the key localizing feature. 1, 5 The 3-day progression indicates this is an acute-on-chronic process that has now reached a critical threshold requiring emergency intervention.