Spinal Cord Compression
The most likely diagnosis is A - Compression of Spinal Cord, given the acute presentation of bilateral lower limb weakness, urinary incontinence, difficulty walking, and a clearly defined T10 sensory level over 3 days. 1
Key Diagnostic Features
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 clinical finding, combined with the triad of motor dysfunction (lower limb weakness), sensory changes (T10 level), and autonomic dysfunction (urinary incontinence), represents an evolving myelopathy requiring emergency intervention. 1
The acute onset over 3 days with bilateral symptoms indicates a structural compressive process rather than inflammatory or demyelinating pathology. 1
Why Not the Other Options
Guillain-Barré Syndrome (Option B)
- Guillain-Barré presents with ascending weakness starting distally in the legs, progressing upward over days to weeks. 1
- It causes areflexia due to peripheral nerve involvement, not a defined sensory level. 1
- The pattern here is descending from a T10 level, which is inconsistent with GBS.
Transverse Myelitis (Option C)
- Transverse myelitis typically follows a viral infection or immune-mediated process. 1
- The absence of infectious prodrome in this case makes structural compression more likely. 1
- While transverse myelitis can present with similar symptoms, the lack of preceding infection and the acute 3-day progression favor a compressive etiology.
Cauda Equina Syndrome (Option D - "Spina cuda symptom")
- Cauda equina affects lumbosacral nerve roots below L1-L2, causing lower motor neuron signs with areflexia. 1, 2
- A T10 sensory level is anatomically too high for cauda equina syndrome. 1
- Cauda equina would present with saddle anesthesia and bilateral sciatica, not a thoracic sensory level. 2
Immediate Management Algorithm
Do not delay imaging - obtain MRI of the entire spine without and with contrast immediately to differentiate between compressive lesions and non-compressive myelopathy. 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
Critical Pitfall to Avoid
The T10 sensory level might tempt clinicians to focus solely on thoracic imaging, but cervical cord compression can present with isolated lower extremity symptoms and urinary incontinence without upper extremity signs. 3, 4, 5 Therefore, imaging the entire spine is essential to avoid missing a higher-level lesion that could be causing these symptoms through descending tract involvement. 1, 3