Spinal Cord Disorders - Differential Diagnosis Framework Spinal cord neurological lesion: Clinical findings: • Symptoms and signs below the site of a lesion. Corticospinal Tract Lesions: • Bilateral findings of: - Spastic paresis/paralysis - Weakness - Hyperreflexia - Muscle spasticity - Extensor plantar responses - Loss of sensation at or below the site of injury - Loss of bowel/bladder continence • Pain reported at level of spinal cord compression • Disruption of bladder bladder continence • Disruption of sensation at or below the site of injury • Gait is abnormal often- Sensory ataxia or spasticity • Lower roots -> Cauda equina- decreased muscle tone, areflexia, loss of perianal sensation Compression of the spinal cord: • Herniated disc • Epidural abscess • Epidural hemorrhage • Cervical spondylosis • Epidural, intradural or intermedullary neoplasm • Posttraumatic compression by fractured vertebral body Non-compressive Spinal Cord Causes: 1. Demyelinating: - Multiple sclerosis - Transverse myelitis - Neuromyelitis optica - Sarcoidosis - Radiation myelopathy - Spinal injuries 2. Infections: - Viral: VZV, HSV, HIV, CMV, HTLV - Mycoplasma, Influenza, EBV, Dengue, Measles, Mumps, WNV - Parasite: Schistosomiasis Toxoplasmosis, Neurocysticercosis - Bacterial: Borrelia, Treponema, Listeria, TB - Spinal abscess: hematogenous spread - Fungal: Actinomyces, Blastomyces dermatitidis, Coccidioides, Aspergillus 3. Vascular/Blockage of the Blood Supply: - AVM - Antiphospholipid and other hypercoagulable states - Hemorrhage - Ant. Spinal artery thrombosis 4. Toxic Metabolic: - Chemotherapy - Radiation myelopathy - Vit B12 and copper levels 5. Inflammatory: - Sarcoidosis, Behcet disease - SLE, Scleroderma, Systemic sclerosis - MCTD, Sjogren syndrome Cord Compression Symptoms: • Back pain • Weakness • Sensory loss: Sensory level (1-5 levels below lesion) • Bowel and bladder dysfunction • Abnormal reflexes: Areflexia UMN Symptoms: • Upper extremity, lower extremity and/or bulbar region • Weakness + slowness • Hyperreflexia • Spasticity • Extensor plantar response LMN Symptoms: • Weakness • Loss of muscle (atrophy) • Muscle twitching (fasciculations) #spinal #cord #spinalcord #disorders #diagnosis #neurology #differential #algorithm
