Differential diagnosis of hereditary spastic paraparesis
| Differential diagnosis | Investigation(s) |
| Cervical/lumbar spondylosis | MRI spine |
| Neoplasm; primary or secondary | MRI brain, spine |
| Arnold Chiari malformation | MRI brain, spine |
| Diplegic cerebral palsy | MRI brain, birth history |
| Spinal cord arteriovenous malformation | MRI/spinal angiography |
| Progressive multiple sclerosis | MRI, CSF analysis, evoked responses |
| Motor neuron disease | EMG |
| Spinocerebellar ataxias | Gene analysis |
| ALD, AMN | MRI brain, VLCFA |
| MLD | MRI brain, arylsulphatase |
| Krabbe leukodystrophy | MRI, galactocerebrosidase |
| Subacute combined degeneration of the cord | Vitamin B12 |
| Arginase deficiency | Plasma arginine, aminoaciduria |
| Neurolathyrism | History ofLathyrus sativus |
| Abetalipoproteinemia | Lipoprotein electrophoresis |
| Dopa responsive dystonia | L-dopa trial, gene analysis |
| Vitamin E deficiency | Serum vitamin E level |
| Neurosyphilis | Syphilis serology |
| HTLV-1 infection (tropical spastic paraparesis) | Serum/CSF HTLV-1 antibodies |
| AIDS | HIV testing, CD4 count |
ALD=adrenoleukodystrophy; AMD=adrenomyeloneuropathy; VLCFA=very long chain fatty acids; MLD=metachromatic leucodystrophy; HTLV-1=human T lymphotropic virus type1; AIDS=acquired immune deficiency syndrome; HIV=human immunodeficiency virus.