Differential Diagnoses for Quadriparesis

1. Differential Diagnoses for Quadriparesis • Trauma • Tumors • Metastatic • Primary • Infection • Bacterial osteomyelitis • Spinal abscess • HIV infection • Inflammatory • Transverse myelitis • Multiple sclerosis • Sytemic lupus erythematosus • Vascular • Anterior spinal artery occlusion • Angioma • AV malformation • Vertebral Disease • Vertebral disk prolapse • Spondylosis • Paget’s disease • Spinal deformity • Others • Hereditary spastic paraparesis • Decompression syndrome • Degenerative motor neuron disease • Epidural intramedullary hemorrhage due to thrombocytopenia/other clotting disorders • Rule out: no evidence of bleeding • Vitamin B12 deficiency

2. Trauma • Most common cause of quadriparesis • Ruled out because the patient has no history of trauma

3. Tumors • Usual presentation is pain, often worse when in supine position, which can be axial (skeletal structures affected) or radicular (nerve roots affected) • Usually presents with constitutional symptoms (night sweats, fever, unexplained weight loss, and anorexia) • Radiographic examination is vital • Can be metastatic (from lungs, breast, prostate and kidney) or primary (multiple myeloma, osteogenic sarcoma, vertebral hemangioma, chondrosarcoma, chordoma, ependymoma, astrocytoma, meningioma, schwannoma, neurofibroma)

4. Infection • Bacterial osteomyelitis • a differential if the patient uses IV drugs, immunosuppressed, or undergoing dialysis • usual etiology is Staphylococcus aureus • Check via culture and inflammatory markers • Spinal abscess • Usually epidural; commonly presents with fever • HIV infection • Can present as primary HIV myelitis, vacuolar myelopathy, or as a result of opportunistic infection

5. Inflammatory • Transverse myelitis • Myelopathic process of unknown cause from inflammation of spinal cord • May start as pain or paresthesia in localized body parts and can progress to paresis and plegia • Multiple sclerosis • Immune-mediated demyelinating disorder which may also initially present as pain and progress to weakness of limbs • Systemic lupus erythematosus • Autoimmune illness which usually presents with other systemic symptoms such as pleuritis, hematologic, immunologic or neurologic alterations, and dermatologic signs

6. Vascular • Ischemia of spinal cord not very common; usually associated with anterior cord syndrome; often from: • Anterior spinal artery occlusion • Angioma • AV malformation

7. Vertebral Disease • Vertebral disk prolapse • Usually due to a tear in the outer fibrous ring (annulus fibrosus) • May initially present as pain of extremities and progress to paresis depending on the level of herniation • Spondylosis • Degenerative odteoarthritis of the spine • Presents as pain, paresthesia or muscle weakness • Paget’s disease • Due to excessive breakdown and formation of bone, followed by disorganized bone remodeling • Causes bone pain but very rarely presents as quadriparesis

8. Others • Epidural intramedullary hemorrhage due to thrombocytopenia/other clotting disorders • Vitamin B12 deficiency • Hereditary spastic paraparesis • Decompression syndrome • Degenerative motor neuron disease