Differential Diagnosis for 74-year-old Female with Lower Back Pain
The patient presents with shooting lower back pain radiating down the left leg, which has been ongoing for 3 days. The pain is severe (8/10), reproducible on palpation, and associated with high blood pressure. Considering these symptoms, the differential diagnosis can be categorized as follows:
- Single most likely diagnosis
- Lumbar Radiculopathy: This condition, often due to a herniated disc, can cause shooting pain down the leg, consistent with the patient's symptoms. The pain being reproducible on palpation and the concern for nerve pain support this diagnosis.
- Other Likely diagnoses
- Lumbar Spinal Stenosis: This condition can cause lower back pain that radiates down the legs, especially with walking or standing, and is common in older adults.
- Degenerative Disc Disease: Wear and tear on the spinal discs can lead to pain, especially if a disc herniates and presses on a nerve, causing radiating pain.
- Hypertensive Emergency: Although the primary complaint is back pain, the significantly elevated blood pressure readings (250/100 and 190/100) could indicate a hypertensive emergency, which might indirectly contribute to or exacerbate the back pain.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Aortic Dissection: Although less likely, given the severe back pain and extremely high blood pressure, aortic dissection must be considered. It is a medical emergency that can present with severe back pain and hypertension.
- Spinal Epidural Abscess: An infection in the spinal epidural space can cause severe back pain, fever, and neurological deficits. It's a rare but potentially deadly condition if not promptly treated.
- Cauda Equina Syndrome: A serious condition that occurs when the nerves in the spinal canal are compressed, leading to loss of bladder and bowel control, among other symptoms. It requires immediate medical attention.
- Rare diagnoses
- Spinal Tumors: Both primary and metastatic tumors can cause back pain and neurological symptoms by compressing nerves.
- Inflammatory Spondyloarthropathies: Conditions like ankylosing spondylitis can cause chronic back pain and stiffness, though they are less common in this age group and presentation.
- Osteoporotic Compression Fracture: Although more common in patients with known osteoporosis, a compression fracture could cause sudden onset back pain, especially if there was a recent fall or trauma.