Spinal Cord Infarction Differential Diagnoses

Updated: Jul 12, 2017
  • Author: Thomas F Scott, MD; Chief Editor: Helmi L Lutsep, MD  more...
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DDx

Diagnostic Considerations

The top priority is to exclude spinal cord compression by a mass lesion. The pathologies associated with spinal cord infarction are numerous and include neoplasm, spinal epidural or subdural abscess, granuloma, spinal epidural or subdural hematoma, extramedullary spinal tumor (including meningioma, neurofibroma, extradural lymphoma, metastasis), and herniated intervertebral disk. Compressive lesions  are "surgical" causes and require prompt diagnosis because of the urgent clinical need for decompression.

Differentiate spinal cord infarction from acute inflammatory demyelinating polyradiculopathy (AIDP, Guillain-Barré syndrome) by following the diagnostic criteria for AIDP. The ADIP radiculopathy usually does not involve sphincter dysfunction and has a different pattern of sensory deficit (typical of peripheral neuropathy), with distal loss in the extremities and lacking a sensory level on the body.

Intraspinal hemorrhage (hematomyelia): Consider the possibility of an underlying arteriovenous malformation of the spinal cord. This is especially important because surgical extirpation may prevent recurrence of hemorrhage and/or progression to more severe disability such as complete paraplegia.

Acute myelopathy

Acute transverse myelopathy

Viral myelitis

Demyelinating disease

Neurosarcoidosis

Tuberculosis

Neurosyphilis

Parasitic diseases (schistosomiasis, cysticercosis)

Differential Diagnoses