Spinal cord compression differential diagnosis: Difference between revisions
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{{Spinal cord compression}} | {{Spinal cord compression}} | ||
==Overview== | ==Overview== | ||
Acute spinal cord compression presents with sudden onset of paralysis along with back pain, it must be differentiated from other diseases with similar presentation such as muscle weakness and back pain. Transverse myelitis, GBS( | Acute [[spinal cord compression]] presents with sudden onset of [[paralysis]] along with [[back pain]], it must be differentiated from other diseases with similar presentation such as [[muscle weakness]] and [[back pain]]. [[Transverse myelitis]], [[Gullian-Barre syndrome|GBS (Gullian-Barrie syndrome)]], [[HIV|HIV-myopathy]], [[diabetic neuropathy]], [[multiple sclerosis]] ([[Multiple sclerosis|MS]]), [[Amyotrophic lateral sclerosis|amyotrophic lateral sclerosis(ALS]]) and [[Neuropathies|peripheral neuropathies]] are some of the diseases to be considered in the differential.<ref name="BehGreenberg2013">{{cite journal|last1=Beh|first1=Shin C.|last2=Greenberg|first2=Benjamin M.|last3=Frohman|first3=Teresa|last4=Frohman|first4=Elliot M.|title=Transverse Myelitis|journal=Neurologic Clinics|volume=31|issue=1|year=2013|pages=79–138|issn=07338619|doi=10.1016/j.ncl.2012.09.008}}</ref><ref name="pmid23628447">{{cite journal |vauthors=van Doorn PA |title=Diagnosis, treatment and prognosis of Guillain-Barré syndrome (GBS) |journal=Presse Med |volume=42 |issue=6 Pt 2 |pages=e193–201 |year=2013 |pmid=23628447 |doi=10.1016/j.lpm.2013.02.328 |url=}}</ref><ref name="pmid11361993">{{cite journal |vauthors=Di Rocco A, Simpson DM |title=AIDS-associated vacuolar myelopathy |journal=AIDS Patient Care STDS |volume=12 |issue=6 |pages=457–61 |year=1998 |pmid=11361993 |doi=10.1089/apc.1998.12.457 |url=}}</ref><ref name="pmid21296405">{{cite journal |vauthors=Kiernan MC, Vucic S, Cheah BC, Turner MR, Eisen A, Hardiman O, Burrell JR, Zoing MC |title=Amyotrophic lateral sclerosis |journal=Lancet |volume=377 |issue=9769 |pages=942–55 |year=2011 |pmid=21296405 |doi=10.1016/S0140-6736(10)61156-7 |url=}}</ref><ref name="pmid11386269">{{cite journal |vauthors=Rowland LP, Shneider NA |title=Amyotrophic lateral sclerosis |journal=N. Engl. J. Med. |volume=344 |issue=22 |pages=1688–700 |year=2001 |pmid=11386269 |doi=10.1056/NEJM200105313442207 |url=}}</ref><ref name="pmid22379455">{{cite journal |vauthors=Loma I, Heyman R |title=Multiple sclerosis: pathogenesis and treatment |journal=Curr Neuropharmacol |volume=9 |issue=3 |pages=409–16 |year=2011 |pmid=22379455 |pmc=3151595 |doi=10.2174/157015911796557911 |url=}}</ref><ref name="pmid22605909">{{cite journal |vauthors=Goldenberg MM |title=Multiple sclerosis review |journal=P T |volume=37 |issue=3 |pages=175–84 |year=2012 |pmid=22605909 |pmc=3351877 |doi= |url=}}</ref><ref name="pmid16461471">{{cite journal |vauthors=Bansal V, Kalita J, Misra UK |title=Diabetic neuropathy |journal=Postgrad Med J |volume=82 |issue=964 |pages=95–100 |year=2006 |pmid=16461471 |pmc=2596705 |doi=10.1136/pgmj.2005.036137 |url=}}</ref><ref name="pmid23112357">{{cite journal |vauthors=Hunter K, Lyon MG |title=Evaluation and management of polymyositis |journal=Indian J Dermatol |volume=57 |issue=5 |pages=371–4 |year=2012 |pmid=23112357 |pmc=3482800 |doi=10.4103/0019-5154.100479 |url=}}</ref> | ||
==Differentiating Spinal Cord Compression from other Diseases== | ==Differentiating Spinal Cord Compression from other Diseases== | ||
Acute spinal cord compression presents with sudden onset of paralysis along with back pain, it must be differentiated from other diseases with similar presentation such as muscle weakness and back pain. Transverse myelitis, GBS( | Acute [[spinal cord compression]] presents with sudden onset of [[paralysis]] along with [[back pain]], it must be differentiated from other diseases with similar presentation such as [[muscle weakness]] and [[back pain]]. [[Transverse myelitis]], [[Gullian-Barre syndrome|GBS(Gullian-Barrie syndrome)]], [[HIV|HIV-myopathy,]] [[diabetic neuropathy]], [[multiple sclerosis]] ([[MS]]), [[amyotrophic lateral sclerosis]]([[Amyotrophic lateral sclerosis|ALS]]) and [[Neuropathies|peripheral neuropathies]] are some of the diseases to be considered in the differential. The following table describes the differentiating signs and symptoms of other diseases from an acute [[spinal cord compression]].<ref name="BehGreenberg2013">{{cite journal|last1=Beh|first1=Shin C.|last2=Greenberg|first2=Benjamin M.|last3=Frohman|first3=Teresa|last4=Frohman|first4=Elliot M.|title=Transverse Myelitis|journal=Neurologic Clinics|volume=31|issue=1|year=2013|pages=79–138|issn=07338619|doi=10.1016/j.ncl.2012.09.008}}</ref><ref name="pmid23628447">{{cite journal |vauthors=van Doorn PA |title=Diagnosis, treatment and prognosis of Guillain-Barré syndrome (GBS) |journal=Presse Med |volume=42 |issue=6 Pt 2 |pages=e193–201 |year=2013 |pmid=23628447 |doi=10.1016/j.lpm.2013.02.328 |url=}}</ref><ref name="pmid11361993">{{cite journal |vauthors=Di Rocco A, Simpson DM |title=AIDS-associated vacuolar myelopathy |journal=AIDS Patient Care STDS |volume=12 |issue=6 |pages=457–61 |year=1998 |pmid=11361993 |doi=10.1089/apc.1998.12.457 |url=}}</ref><ref name="pmid21296405">{{cite journal |vauthors=Kiernan MC, Vucic S, Cheah BC, Turner MR, Eisen A, Hardiman O, Burrell JR, Zoing MC |title=Amyotrophic lateral sclerosis |journal=Lancet |volume=377 |issue=9769 |pages=942–55 |year=2011 |pmid=21296405 |doi=10.1016/S0140-6736(10)61156-7 |url=}}</ref><ref name="pmid11386269">{{cite journal |vauthors=Rowland LP, Shneider NA |title=Amyotrophic lateral sclerosis |journal=N. Engl. J. Med. |volume=344 |issue=22 |pages=1688–700 |year=2001 |pmid=11386269 |doi=10.1056/NEJM200105313442207 |url=}}</ref><ref name="pmid22379455">{{cite journal |vauthors=Loma I, Heyman R |title=Multiple sclerosis: pathogenesis and treatment |journal=Curr Neuropharmacol |volume=9 |issue=3 |pages=409–16 |year=2011 |pmid=22379455 |pmc=3151595 |doi=10.2174/157015911796557911 |url=}}</ref><ref name="pmid22605909">{{cite journal |vauthors=Goldenberg MM |title=Multiple sclerosis review |journal=P T |volume=37 |issue=3 |pages=175–84 |year=2012 |pmid=22605909 |pmc=3351877 |doi= |url=}}</ref><ref name="pmid16461471">{{cite journal |vauthors=Bansal V, Kalita J, Misra UK |title=Diabetic neuropathy |journal=Postgrad Med J |volume=82 |issue=964 |pages=95–100 |year=2006 |pmid=16461471 |pmc=2596705 |doi=10.1136/pgmj.2005.036137 |url=}}</ref><ref name="pmid23112357">{{cite journal |vauthors=Hunter K, Lyon MG |title=Evaluation and management of polymyositis |journal=Indian J Dermatol |volume=57 |issue=5 |pages=371–4 |year=2012 |pmid=23112357 |pmc=3482800 |doi=10.4103/0019-5154.100479 |url=}}</ref> | ||
{| class="wikitable" | {| class="wikitable" | ||
| Line 15: | Line 15: | ||
|'''Other diagnostic tests''' | |'''Other diagnostic tests''' | ||
|- | |- | ||
|Transverse myelitis | |[[Transverse myelitis]] | ||
|Febrile illness preceding the symptoms | |Febrile illness preceding the symptoms | ||
[[Lower extremities|Lower extremity]] > [[Upper extremity]] | |||
|Pleocytosis | |[[Pleocytosis]] | ||
↑Total protein | ↑Total protein | ||
|Focal demyelination on MRI | |Focal [[demyelination]] on MRI | ||
|- | |- | ||
| | |[[Gullian-Barre syndrome]] (GBS) | ||
|History of gastroenteritis or influenza-like illness | |History of [[gastroenteritis]] or [[influenza-like illness]] | ||
Ascending paralysis | [[Ascending paralysis]] | ||
Loss of deep tendon reflexes | Loss of [[Reflexes|deep tendon reflexes]] | ||
Respiratory muscle weakness requiring ventilation | Respiratory muscle weakness requiring ventilation | ||
| Line 32: | Line 32: | ||
↑Total protein | ↑Total protein | ||
|EMG shows decreased conduction | |[[Electromyography|EMG]] shows decreased conduction. | ||
Seropositive for Campylobacter jejuni (50% cases) | Seropositive for [[Campylobacter jejuni]] (50% cases). | ||
|- | |- | ||
|HIV-related myelopathy | |[[HIV|HIV-related myelopathy]] | ||
|History of HIV infection | |History of [[HIV AIDS|HIV infection]] | ||
Paraparesis, spasticity or ataxia | [[Paraparesis]], [[spasticity]] or [[ataxia]] coupled with [[dementia]] | ||
|Nonspecific | |Nonspecific | ||
|ELISA | |[[Enzyme linked immunosorbent assay (ELISA)|ELISA]] positive, followed by confirmation with [[Western blot]]. | ||
|- | |- | ||
|Amyotrophic lateral sclerosis (ALS) | |[[Amyotrophic lateral sclerosis]] (ALS) | ||
|Combination of UMN and LMN | |Combination of [[Upper motor neuron|UMN]] and [[Lower motor neuron|LMN]] lesion symptoms | ||
Muscle weakness and stiffness as the initial symptoms | [[Muscle weakness]] and [[stiffness]] as the initial symptoms | ||
|Nonspecific | |Nonspecific | ||
|Fibrillation potentials and positive sharp waves, with fasciculation potentials on EMG | |Fibrillation potentials and positive sharp waves, with fasciculation potentials on [[Electromyography|EMG]] | ||
|- | |- | ||
|Multiple sclerosis | |[[Multiple sclerosis]] | ||
|Mimic clinical symptoms of spinal | |Mimic clinical symptoms of spinal compression. | ||
All cases involve the brain. | |||
Presents with multiple episodes separated by space with self-resolution | Presents with multiple episodes separated by space with self-resolution | ||
Visual symptom (neuromyelitis optica) distinct for MS | Visual symptom ([[neuromyelitis optica]]) distinct for MS | ||
|↑ IgG and oligobands | |↑ [[Immunoglobulin G|IgG]] and oligobands | ||
|MRI brain shows areas of demyelination. | |MRI brain shows areas of [[Demyelination|demyelination.]] | ||
|- | |- | ||
|Diabetic neuropathy | |[[Diabetic neuropathy]] | ||
|History of diabetes mellitus. | |History of [[diabetes mellitus]]. | ||
Pain and loss of sensation in the feet in a glove-and-stocking distribution. | Pain and loss of sensation in the feet in a glove-and-stocking distribution. | ||
Bladder dysfunction may be present due to autonomic neuropathy. | Bladder dysfunction may be present due to [[Autonomic neuropathy|autonomic neuropathy.]] | ||
|Nonspecific | |Nonspecific | ||
|EMG shows reduction in sensory nerve conduction and a decrease in amplitude. | |[[Electromyography|EMG]] shows reduction in sensory nerve conduction and a decrease in amplitude. | ||
|- | |- | ||
|Polymyositis | |[[Polymyositis]] | ||
|Symmetrical weakness of shoulder and pelvic girdles. | |Symmetrical [[weakness]] of [[Shoulder girdle|shoulder and pelvic girdles]]. | ||
|Nonspecific | |Nonspecific | ||
|EMG include spontaneous fibrillations, low-amplitude short-duration polyphasic motor potentials | |[[EMG]] include spontaneous fibrillations, low-amplitude short-duration polyphasic motor potentials. | ||
Muscle biopsy shows immune cell infiltration and destruction of muscle fibers | Muscle biopsy shows immune cell [[Infiltration (medical)|infiltration]] and destruction of [[muscle fibers]]. | ||
|- | |- | ||
|Hereditary muscular dystrophy | |[[Muscular dystrophy|Hereditary muscular dystrophy]] | ||
|Proximal and distal muscle weakness | |Proximal and distal [[muscle weakness]] | ||
Without sensory changes in the initial stages. | Without sensory changes in the initial stages. | ||
|Nonspecific | |Nonspecific | ||
|MRI and EMG/nerve conduction studies will show only myopathic changes | |[[MRI]] and EMG/nerve conduction studies will show only [[myopathic]] changes | ||
|} | |} | ||
Latest revision as of 17:44, 18 April 2017
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Overview
Acute spinal cord compression presents with sudden onset of paralysis along with back pain, it must be differentiated from other diseases with similar presentation such as muscle weakness and back pain. Transverse myelitis, GBS (Gullian-Barrie syndrome), HIV-myopathy, diabetic neuropathy, multiple sclerosis (MS), amyotrophic lateral sclerosis(ALS) and peripheral neuropathies are some of the diseases to be considered in the differential.[1][2][3][4][5][6][7][8][9]
Differentiating Spinal Cord Compression from other Diseases
Acute spinal cord compression presents with sudden onset of paralysis along with back pain, it must be differentiated from other diseases with similar presentation such as muscle weakness and back pain. Transverse myelitis, GBS(Gullian-Barrie syndrome), HIV-myopathy, diabetic neuropathy, multiple sclerosis (MS), amyotrophic lateral sclerosis(ALS) and peripheral neuropathies are some of the diseases to be considered in the differential. The following table describes the differentiating signs and symptoms of other diseases from an acute spinal cord compression.[1][2][3][4][5][6][7][8][9]
| Disease/Condition | Differentiating Signs/Symptoms | Differentiating Tests | |
|---|---|---|---|
| CSF Findings | Other diagnostic tests | ||
| Transverse myelitis | Febrile illness preceding the symptoms | Pleocytosis
↑Total protein |
Focal demyelination on MRI |
| Gullian-Barre syndrome (GBS) | History of gastroenteritis or influenza-like illness
Loss of deep tendon reflexes Respiratory muscle weakness requiring ventilation |
Albumin-cytologic dissociation
↑Total protein |
EMG shows decreased conduction.
Seropositive for Campylobacter jejuni (50% cases). |
| HIV-related myelopathy | History of HIV infection
Paraparesis, spasticity or ataxia coupled with dementia |
Nonspecific | ELISA positive, followed by confirmation with Western blot. |
| Amyotrophic lateral sclerosis (ALS) | Combination of UMN and LMN lesion symptoms
Muscle weakness and stiffness as the initial symptoms |
Nonspecific | Fibrillation potentials and positive sharp waves, with fasciculation potentials on EMG |
| Multiple sclerosis | Mimic clinical symptoms of spinal compression.
All cases involve the brain. Presents with multiple episodes separated by space with self-resolution Visual symptom (neuromyelitis optica) distinct for MS |
↑ IgG and oligobands | MRI brain shows areas of demyelination. |
| Diabetic neuropathy | History of diabetes mellitus.
Pain and loss of sensation in the feet in a glove-and-stocking distribution. Bladder dysfunction may be present due to autonomic neuropathy. |
Nonspecific | EMG shows reduction in sensory nerve conduction and a decrease in amplitude. |
| Polymyositis | Symmetrical weakness of shoulder and pelvic girdles. | Nonspecific | EMG include spontaneous fibrillations, low-amplitude short-duration polyphasic motor potentials.
Muscle biopsy shows immune cell infiltration and destruction of muscle fibers. |
| Hereditary muscular dystrophy | Proximal and distal muscle weakness
Without sensory changes in the initial stages. |
Nonspecific | MRI and EMG/nerve conduction studies will show only myopathic changes |
References
- ↑ 1.0 1.1 Beh, Shin C.; Greenberg, Benjamin M.; Frohman, Teresa; Frohman, Elliot M. (2013). "Transverse Myelitis". Neurologic Clinics. 31 (1): 79–138. doi:10.1016/j.ncl.2012.09.008. ISSN 0733-8619.
- ↑ 2.0 2.1 van Doorn PA (2013). "Diagnosis, treatment and prognosis of Guillain-Barré syndrome (GBS)". Presse Med. 42 (6 Pt 2): e193–201. doi:10.1016/j.lpm.2013.02.328. PMID 23628447.
- ↑ 3.0 3.1 Di Rocco A, Simpson DM (1998). "AIDS-associated vacuolar myelopathy". AIDS Patient Care STDS. 12 (6): 457–61. doi:10.1089/apc.1998.12.457. PMID 11361993.
- ↑ 4.0 4.1 Kiernan MC, Vucic S, Cheah BC, Turner MR, Eisen A, Hardiman O, Burrell JR, Zoing MC (2011). "Amyotrophic lateral sclerosis". Lancet. 377 (9769): 942–55. doi:10.1016/S0140-6736(10)61156-7. PMID 21296405.
- ↑ 5.0 5.1 Rowland LP, Shneider NA (2001). "Amyotrophic lateral sclerosis". N. Engl. J. Med. 344 (22): 1688–700. doi:10.1056/NEJM200105313442207. PMID 11386269.
- ↑ 6.0 6.1 Loma I, Heyman R (2011). "Multiple sclerosis: pathogenesis and treatment". Curr Neuropharmacol. 9 (3): 409–16. doi:10.2174/157015911796557911. PMC 3151595. PMID 22379455.
- ↑ 7.0 7.1 Goldenberg MM (2012). "Multiple sclerosis review". P T. 37 (3): 175–84. PMC 3351877. PMID 22605909.
- ↑ 8.0 8.1 Bansal V, Kalita J, Misra UK (2006). "Diabetic neuropathy". Postgrad Med J. 82 (964): 95–100. doi:10.1136/pgmj.2005.036137. PMC 2596705. PMID 16461471.
- ↑ 9.0 9.1 Hunter K, Lyon MG (2012). "Evaluation and management of polymyositis". Indian J Dermatol. 57 (5): 371–4. doi:10.4103/0019-5154.100479. PMC 3482800. PMID 23112357.