Differential Diagnosis for Bilateral Lower Extremity Weakness and Bilateral Hand Contractures Following a Fall
- Single Most Likely Diagnosis
- Spinal Cord Injury (SCI): A fall can cause trauma to the spinal cord, leading to bilateral lower extremity weakness due to the interruption of neural pathways. Hand contractures could develop over time due to immobilization or as a complication of the injury, especially if the injury is at a higher level of the spinal cord affecting the use of the hands.
- Other Likely Diagnoses
- Stroke or Cerebral Vasculitis: Although less common, a fall could be a consequence of a stroke, and if the stroke affects both sides of the brain (e.g., bilateral anterior cerebral artery territory infarcts), it could lead to bilateral lower extremity weakness. Hand contractures might develop later due to spasticity and lack of movement.
- Guillain-Barré Syndrome (GBS): This is an autoimmune disorder that can cause ascending paralysis, starting with the lower extremities and potentially leading to bilateral weakness. While hand contractures are not a primary feature, prolonged immobilization could contribute to their development.
- Multiple Sclerosis (MS): A demyelinating disease of the central nervous system that can present with a wide range of neurological symptoms, including bilateral weakness and, over time, contractures due to spasticity.
- Do Not Miss Diagnoses
- Cauda Equina Syndrome: A serious condition that occurs when the nerves in the spinal canal are compressed, often due to a herniated disk. It requires urgent surgical intervention to prevent permanent damage, which could include bilateral lower extremity weakness and, if not promptly treated, could lead to complications like contractures.
- Spinal Epidural Abscess or Hematoma: Infections or bleeding in the spinal canal can compress the spinal cord, leading to rapid onset of neurological deficits, including bilateral weakness. Prompt recognition and treatment are crucial to prevent permanent damage or death.
- Rare Diagnoses
- Tetanus: A bacterial infection characterized by muscle stiffness and spasms, which could lead to contractures. While rare in regions with good vaccination coverage, it's a possibility if the patient has not been vaccinated or has been exposed to the bacteria through a wound.
- Neurodegenerative Diseases (e.g., Amyotrophic Lateral Sclerosis - ALS): These conditions can cause progressive muscle weakness and could potentially lead to contractures over time. However, their onset is typically more gradual than what would be expected following a fall.