Differential Diagnosis for Postoperative Difficulty Walking
- Single most likely diagnosis
- Femoral nerve injury: This is the most likely diagnosis given the patient's symptoms of diminished sensation on the left anterior and medial thigh, weakness on knee extension, and decreased left patellar reflex. The femoral nerve can be injured during cesarean delivery, especially with a Pfannenstiel incision, or as a result of the epidural analgesia.
- Other Likely diagnoses
- Epidural hematoma or abscess: Although less likely, these conditions can cause neurological deficits, including weakness and sensory changes, due to compression of the spinal cord or nerves.
- Spinal epidural hematoma: This is a possible complication of epidural placement, which can cause compression of the spinal cord and lead to neurological deficits.
- Lumbosacral plexus injury: The lumbosacral plexus can be injured during cesarean delivery, especially with a difficult or prolonged surgery, leading to neurological deficits.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Spinal cord injury: Although rare, spinal cord injury can occur during cesarean delivery or epidural placement, leading to severe and potentially permanent neurological deficits.
- Deep vein thrombosis (DVT) with pulmonary embolism: While not directly related to the neurological symptoms, DVT and pulmonary embolism are potential postoperative complications that can be life-threatening if missed.
- Rare diagnoses
- Meralgia paresthetica: This is a rare condition characterized by compression of the lateral femoral cutaneous nerve, leading to sensory changes on the lateral thigh.
- Rhabdomyolysis: This is a rare condition characterized by muscle breakdown, which can occur after prolonged surgery or immobilization, leading to muscle weakness and other systemic symptoms.