Differential Diagnosis
- Single most likely diagnosis
- Tethered cord: This condition is the most likely diagnosis given the patient's progressive difficulty walking, back pain, and recent onset of urinary incontinence. Tethered cord syndrome can cause a range of symptoms, including motor weakness, sensory deficits, and bladder and bowel dysfunction, which align with the patient's presentation.
- Other Likely diagnoses
- Muscular dystrophy: While muscular dystrophy could explain the patient's progressive difficulty walking and decreased strength, it does not typically cause urinary incontinence or back pain. However, it remains a possible diagnosis that should be considered.
- Spastic diplegia: This condition is a form of cerebral palsy that can cause muscle stiffness and weakness, particularly in the legs. However, it typically presents at a younger age and may not fully explain the patient's recent onset of urinary incontinence.
- Do Not Miss
- Transverse myelitis: Although less likely, transverse myelitis is a serious condition that can cause rapid onset of symptoms, including weakness, sensory deficits, and bladder and bowel dysfunction. It is essential to consider this diagnosis, as prompt treatment can improve outcomes.
- Spinal cord tumor or compression: While not explicitly listed, spinal cord tumors or compression can cause similar symptoms to tethered cord syndrome and should be considered to avoid missing a potentially life-threatening condition.
- Rare diagnoses
- Inherited neuropathies (e.g., Charcot-Marie-Tooth disease): These conditions can cause progressive weakness and sensory deficits but are less likely to cause urinary incontinence or back pain.
- Inflammatory or infectious myelopathies: Conditions such as multiple sclerosis or spinal cord infections can cause a range of symptoms, including weakness, sensory deficits, and bladder and bowel dysfunction, but are relatively rare in children.