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

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

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)

Infection Bacterial osteomyelitis Spinal abscess HIV infection 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

Inflammatory Transverse myelitis Multiple sclerosis 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

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

Vertebral Disease Vertebral disk prolapse Spondylosis Paget’s disease 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

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