Differential Diagnosis for a Child Unable to Move Legs with a History of Sinusitis
Single Most Likely Diagnosis
- Transient Mononeuropathy or Peripheral Nerve Compression: This condition could be caused by a viral infection, such as the one that led to sinusitis, and can result in temporary weakness or paralysis of a limb. The fact that symptoms resolved 4 days later supports this diagnosis, as it is often self-limiting.
Other Likely Diagnoses
- Guillain-Barré Syndrome (GBS): Although less common, GBS is an autoimmune disorder that can occur after a viral infection, leading to muscle weakness and sometimes paralysis. The recent history of sinusitis could be a triggering event.
- Viral Myelitis: Direct infection of the spinal cord by a virus can cause symptoms like leg weakness. The resolution of symptoms could indicate a self-limiting viral process.
- Discitis or Osteomyelitis: Infections of the spine or bones could cause neurological symptoms due to compression or inflammation affecting the spinal cord or nerves.
Do Not Miss Diagnoses
- Spinal Cord Compression or Tumor: Although rare, any condition causing compression of the spinal cord (e.g., tumor, abscess) is a medical emergency requiring immediate intervention to prevent permanent damage.
- Epidural Abscess: A collection of pus in the epidural space surrounding the spinal cord can compress the cord and cause neurological deficits, including paralysis. Prompt diagnosis and treatment are crucial.
- Transverse Myelitis: An inflammatory condition affecting the spinal cord, which can be caused by infections, autoimmune diseases, or other factors. It requires prompt treatment to prevent long-term damage.
Rare Diagnoses
- Acute Flaccid Myelitis (AFM): A rare but serious condition that affects the spinal cord, causing muscle weakness and paralysis. It has been associated with viral infections.
- Neurosarcoidosis: A condition where sarcoidosis, an autoimmune disease, affects the nervous system, potentially causing a wide range of neurological symptoms, including paralysis.
- Vasculitis Affecting the Spinal Cord: Inflammation of blood vessels supplying the spinal cord can lead to ischemia and neurological deficits. This is a rare but potentially devastating condition if not promptly treated.