Differential Diagnosis for Bilateral Lower Extremity Weakness, Hand Contractures, and Muscle Fasciculations after a Fall
- Single Most Likely Diagnosis + Amyotrophic Lateral Sclerosis (ALS): This condition is characterized by progressive muscle weakness, atrophy, and fasciculations. The presence of hand contractures and bilateral lower extremity weakness, combined with muscle fasciculations, makes ALS a strong consideration. The fall could be a consequence of the muscle weakness.
- Other Likely Diagnoses + Spinal Cord Injury: A fall could result in a spinal cord injury, leading to bilateral lower extremity weakness. Hand contractures could develop over time due to immobility and muscle imbalance. Fasciculations might be seen if there is damage to the anterior horn cells. + Peripheral Neuropathy: Certain types of peripheral neuropathy, such as Charcot-Marie-Tooth disease, can cause bilateral lower extremity weakness and hand contractures. Fasciculations might be present in some cases, especially if there is associated nerve root damage. + Multifocal Motor Neuropathy: This condition is characterized by asymmetric muscle weakness, atrophy, and fasciculations. While it typically affects the upper limbs, it could potentially cause bilateral lower extremity weakness.
- Do Not Miss Diagnoses + Spinal Epidural Abscess: This is a medical emergency that can cause rapid progression of neurological deficits, including bilateral lower extremity weakness. Hand contractures and fasciculations might not be the primary presenting features, but the condition's severity and potential for devastating outcomes if missed make it crucial to consider. + Cauda Equina Syndrome: Similar to spinal epidural abscess, cauda equina syndrome is a medical emergency that requires prompt attention. It can cause bilateral lower extremity weakness, among other symptoms, and has the potential for severe and permanent neurological damage if not treated promptly.
- Rare Diagnoses + Kennedy's Disease (Spinal and Bulbar Muscular Atrophy): This is a rare X-linked recessive disorder that affects males and is characterized by progressive muscle weakness, atrophy, and fasciculations. It could potentially cause bilateral lower extremity weakness and hand contractures. + Tetanus: While rare in developed countries, tetanus infection can cause muscle stiffness, rigidity, and spasms, potentially leading to hand contractures and bilateral lower extremity weakness. Fasciculations might be seen in some cases.