🦽 Paraplegia · Spinal Cord Syndromes · Transverse Myelitis · GBS · Trauma · Tumor

Schwartz Clinical Handbook — Chapter 58 · Acute vs chronic · Sensory level · Reflexes · MRI · Cord compression · Guillain‑Barré · Epidural abscess

Select onset (acute, subacute, chronic), sensory level, reflexes (areflexia vs hyperreflexia), bowel/bladder dysfunction, back pain, fever, trauma history, and MRI clues → differentiate transverse myelitis, Guillain‑Barré, spinal cord infarction, epidural abscess, tumor, trauma, or hereditary spastic paraparesis.
⚠️ Red flags: acute cord compression (pain, weakness, sensory level, sphincter loss) → emergent MRI, dexamethasone, neurosurgery.

📋 Step 1 — Onset, exam & imaging clues
📌 Diagnostic impressions
📖 Schwartz Ch 58

Select onset (acute hours‑days, subacute weeks, chronic), sensory level, reflexes (areflexia vs hyperreflexia), bowel/bladder, back pain, fever, trauma, and MRI → differentiate transverse myelitis, GBS, spinal cord infarction, epidural abscess, tumor, trauma (SCIWORA), or hereditary spastic paraplegia.

✔️ Acute flaccid areflexia + ascending weakness → Guillain‑Barré (CSF protein ↑, cells normal).
✔️ Subacute sensory level + hyperreflexia + MRI cord T2 hyperintensity → transverse myelitis.
✔️ Fever + severe back pain + epidural enhancement → epidural abscess (urgent surgery).
✔️ Trauma + weakness → spinal cord injury (CT/MRI, immobilize).
✔️ Chronic progressive + family history → hereditary spastic paraplegia.
📘 Schwartz pearls (Chapter 58)
• MRI spine with contrast is study of choice (cord compression, inflammation, tumor).
• GBS: ascending paralysis, areflexia, respiratory monitoring, IVIG/plasmapheresis.
• Epidural abscess: urgent MRI, neurosurgery, IV antibiotics (vancomycin + ceftriaxone).
• Transverse myelitis: corticosteroids (methylprednisolone), treat underlying autoimmune.
• SCIWORA: spinal cord injury without radiographic abnormality in children.