Tabes Dorsalis differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohamadmostafa Jahansouz M.D.[2]

Overview

Tabes dorsalis must be differentiated from other diseases that cause lightning pains, impaired sensation, ataxia and unsteady gait, such as vitamin B12 deficiency, extrinsic spinal cord compression, vitamin E deficiency and multiple sclerosis.

Differentiating tabes dorsalis from other Diseases

• Tabes dorsalis must be differentiated from other diseases that cause lightning pains, impaired sensation and proprioception, and progressive sensory ataxia and unsteady gait (locomotor ataxia) and sexual function problems, such as vitamin B12 deficiency, extrinsic spinal cord compression, vitamin E deficiency and multiple sclerosis.

Diseases	History and symptoms				Physical examination				Laboratory findings	Other findings
	Lightning pains	Impaired sensation	Progressive sensory ataxia	Unsteady gait	Argyll-Robertson pupils	Impaired vibratory and proprioception sense	Broad base and sensory ataxic gait	Positive Romberg's test
Tabes dorsalis	++	++	++	++	++	++	++	++	Positive VDRL Rapid plasma reagent FTA-ABS tests	-
B12 deficiency	+/-	+	+	+/-	+/-	++	+	+/-	Megaloblastic anemia, Low plasma methylmalonic acid level	Gastrointestinal symptoms Glossitis
Spinal cord compression	+/-	+/-	+/-	+/-	-	+/-	+/-	-	-	May be acute, subacute or chronic
Vitamin E deficiency	+/-	+	+	+/-	-	+/-	-	-	Hemolytic anemia	Muscle Weakness Retinopathy
Multiple sclerosis	+/-	+/-	+/-	+/-	Very rare	+/-	-	+/-	Oligoclonal bands of IgG on electrophoresis of cerebrospinal fluid	Vision problems Balance problems Dizziness Areas of demyelination in CNS MRI