1. 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

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 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

5. 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

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 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

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