Table 3.
Conditions and investigations to be considered in the differential diagnosis of pure HSP
| Structural and vascular | |
| Arterio-venous dural fistula [77] | MRI/angiogram |
| Spinal or parasagittal tumour | MRI |
| Spondylosis | MRI |
| Inflammatory | |
| Multiple Sclerosis | MRI, CSF |
| Vasculitic Myelopathy [36] | Autoimmune profile |
| Stiff person syndrome [78] | Neurophysiology, antibody testing |
| Sarcoidosis [79] | MRI, CSF, chest X-ray |
| Metabolic (acquired and hereditary) | |
| Vitamin deficiency (B12, E) | Vitamin levels |
| Nitrous oxide toxicity [80] | History, B12 level |
| Adrenoleucodystrophy and other leucodystrophies [81, 82] | White cell enzymes, VLCFA, MRI |
| Copper deficiency myelopathy [83] | Copper levels |
| Degenerative | |
| Primary lateral sclerosis | Neurophysiology and evolution of clinical picture |
| Infectious | |
| Tropical spastic paraparesis [37] | HTLV—1 serology, CSF |
| HIV myelopathy [38] | HIV serology, CSF |
| Syphilis | Syphilis serology, CSF |
| Other | |
| Radiation myelopathy [84] | History, imaging |
| Spinocerebellar ataxias and other genetic conditions (see text and [39]) | Genetic testing. Trial of l-dopa |