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| __NOTOC__
| | <div class="mw-customtoggle-x1" style="cursor: pointer; font-weight: bold; color: #0645AD;"> |
| {{Meningitis}}
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| {{CMG}}; {{AE}}{{MehdiP}}
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| ==Overview==
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| ==Causes==
| | CLICK HERE TO SEE THE CORRECTION |
| <br>
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| {| align=center
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| {| style="border: 0px; font-size: 90%; margin: 3px;" align=center
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| !align="center" style="background:#4479BA; color: #FFFFFF;" |Etiology
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| !align="center" style="background:#4479BA; color: #FFFFFF;" |Common causes
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| !align="center" style="background:#4479BA; color: #FFFFFF;" |Less common causes
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| |-
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| |style="padding: 5px 5px; background: #DCDCDC;" align="center" |Bacterial
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| |style="padding: 5px 5px; background: #F5F5F5;" align="left" |
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| * [[Streptococcus pneumoniae]]
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| * [[Neisseria meningitis]]
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| * [[Haemophilus influenzae|Hemophilus influenza]]
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| * [[Group B streptococcus]]
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| * [[Listeria monocytogenes]]
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| |style="padding: 5px 5px; background: #F5F5F5;" align="left" |
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| * [[Staphylococcus aureus]]
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| * [[Klebsiella]]
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| * [[Pseudomonas]]
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| * [[Escherichia coli|E. coli]]
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| * [[Kingella|Kingella Kingae]]
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| * [[Mycobacterium tuberculosis]]
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| * [[Corynebacterium|Diphtheroids]]
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| * [[Propionibacterium acnes]]
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| * [[Serratia marcescens]]
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| * [[Salmonella|Salmonella species]]
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| * [[Brucella|Brucella sp]]
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| * [[Nocardia]]
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| * [[Francisella tularensis]]
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| * [[Streptococcus suis]]
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| * [[Ehrlichia|Ehrlichia chaffeensis]]
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| | </div> |
| |style="padding: 5px 5px; background: #DCDCDC;" align="center" |Viral
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| |style="padding: 5px 5px; background: #F5F5F5;" align="left" |
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| * [[Enteroviruses]]
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| * [[Herpes simplex]] [[viruses]] 1 and 2
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| * [[Arboviruses]]
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| |style="padding: 5px 5px; background: #F5F5F5;" align="left" |
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| * [[Influenza virus]]
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| * [[Herpes zoster]]
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| * [[HHV-6 encephalitis|Human Herpes Virus 6]]
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| * [[Epstein barr virus mononucleosis|Epstein barr virus]] (EBV)
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| * [[Lymphocytic choriomeningitis virus]]
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| * [[Mumps]]
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| * [[Cytomegalovirus|Cytomegalo virus]] (CMV)
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| * [[Human Immunodeficiency Virus (HIV)|Human immunodeficiency virus]] (HIV)
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| * [[West nile virus]]
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| * [[HTLV|Human T cell lymphotrophic virus]] I and II
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| * [[Varicella zoster virus]]
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| |-
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| |style="padding: 5px 5px; background: #DCDCDC;" align="center" |Fungal
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| |style="padding: 5px 5px; background: #F5F5F5;" align="left" |
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| * [[Cryptococcus neoformans]]
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| *[[Aspergillus]] sp.
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| *[[Blastomyces dermatitidis]]
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| *[[Coccidioides immitis]]
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| *[[Candida]] spp.
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| *[[Histoplasma capsulatum]]
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| *[[Sporothrix schenckii|Sporothrix schencki]]
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| |style="padding: 5px 5px; background: #F5F5F5;" align="left" |
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| *Xylohypha (formerly [[Cladosporium]]) trichoides and other dark-walled (demateaceous) fungi such as [[Curvularia]] and Drechslera
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| *[[Mucor]]
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| *Arthrographis kalrae
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| *[[Pneumocystis jirovecii]]<ref name="pmid9495679">{{cite journal| author=Villanueva JL, Cordero E, Caballero-Granado FJ, Regordan C, Becerril B, Pachón J| title=Pneumocystis carinii meningoradiculitis in a patient with AIDS. | journal=Eur J Clin Microbiol Infect Dis | year= 1997 | volume= 16 | issue= 12 | pages= 940-2 | pmid=9495679 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9495679 }}</ref><ref name="pmid9629775">{{cite journal| author=Baena Luna MR, Muñoz García J, Grancha Bertolín L, Sanz García M| title=[Presence of Pneumocystis carinii in cerebrospinal fluid]. | journal=An Med Interna | year= 1998 | volume= 15 | issue= 5 | pages= 265-6 | pmid=9629775 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9629775 }}</ref>
| |
| *[[Cryptococcus]] albidus<ref name="pmid7185917">{{cite journal| author=Melo JC, Srinivasan S, Scott ML, Raff MJ| title=Cryptococcus albidus meningitis. | journal=J Infect | year= 1980 | volume= 2 | issue= 1 | pages= 79-82 | pmid=7185917 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7185917 }}</ref>
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| *[[Alternaria]] spp<ref name="pmid13730495">{{cite journal| author=OHASHI Y| title=On a rare disease due to Alternaria tenuis Nees (alternariasis). | journal=Tohoku J Exp Med | year= 1960 | volume= 72 | issue= | pages= 78-82 | pmid=13730495 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=13730495 }}</ref>
| | <div class="mw-collapsible mw-collapsed" id="mw-customcollapsible-x1"> |
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| *[[Rhodotorula]] spp <ref name="pmid18974495">{{cite journal| author=Shinde RS, Mantur BG, Patil G, Parande MV, Parande AM| title=Meningitis due to Rhodotorula glutinis in an HIV infected patient. | journal=Indian J Med Microbiol | year= 2008 | volume= 26 | issue= 4 | pages= 375-7 | pmid=18974495 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18974495 }}</ref>
| | [[image:Passage-4.gif]] |
| | <br clear="left"/> |
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| *[[Acremonium]] spp.<ref name="pmid1956281">{{cite journal| author=Fincher RM, Fisher JF, Lovell RD, Newman CL, Espinel-Ingroff A, Shadomy HJ| title=Infection due to the fungus Acremonium (cephalosporium). | journal=Medicine (Baltimore) | year= 1991 | volume= 70 | issue= 6 | pages= 398-409 | pmid=1956281 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1956281 }}</ref>
| | </div> |
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| *Dreschlera spp<ref name="pmid4739938">{{cite journal| author=Fuste FJ, Ajello L, Threlkeld R, Henry JE| title=Drechslera hawaiiensis: causative agent of a fatal fungal meningo-encephalitis. | journal=Sabouraudia | year= 1973 | volume= 11 | issue= 1 | pages= 59-63 | pmid=4739938 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4739938 }}</ref>
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| *[[Malassezia]] spp<ref name="pmid15255040">{{cite journal| author=Rosales CM, Jackson MA, Zwick D| title=Malassezia furfur meningitis associated with total parenteral nutrition subdural effusion. | journal=Pediatr Dev Pathol | year= 2004 | volume= 7 | issue= 1 | pages= 86-90 | pmid=15255040 | doi=10.1007/s10024-003-4030-5 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15255040 }}</ref>
| | <div class="mw-customtoggle-x1" style="cursor: pointer; font-weight: bold; color: #0645AD;"> |
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| *[[Scedosporium apiospermum|Scedosporium]] spp<ref name="pmid16678041">{{cite journal| author=Symoens F, Knoop C, Schrooyen M, Denis O, Estenne M, Nolard N et al.| title=Disseminated Scedosporium apiospermum infection in a cystic fibrosis patient after double-lung transplantation. | journal=J Heart Lung Transplant | year= 2006 | volume= 25 | issue= 5 | pages= 603-7 | pmid=16678041 | doi=10.1016/j.healun.2005.12.011 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16678041 }}</ref>
| | CLICK HERE TO SEE THE CORRECTION |
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| *Arthrographis spp<ref name="pmid11158158">{{cite journal| author=Chin-Hong PV, Sutton DA, Roemer M, Jacobson MA, Aberg JA| title=Invasive fungal sinusitis and meningitis due to Arthrographis kalrae in a patient with AIDS. | journal=J Clin Microbiol | year= 2001 | volume= 39 | issue= 2 | pages= 804-7 | pmid=11158158 | doi=10.1128/JCM.39.2.804-807.2001 | pmc=87827 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11158158 }}</ref>
| | </div> |
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| *Blastoschizomyces<ref name="pmid1810730">{{cite journal| author=Girmenia C, Micozzi A, Venditti M, Meloni G, Iori AP, Bastianello S et al.| title=Fluconazole treatment of Blastoschizomyces capitatus meningitis in an allogeneic bone marrow recipient. | journal=Eur J Clin Microbiol Infect Dis | year= 1991 | volume= 10 | issue= 9 | pages= 752-6 | pmid=1810730 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1810730 }}</ref><ref name="pmid2324536">{{cite journal| author=Naficy AB, Murray HW| title=Isolated meningitis caused by Blastoschizomyces capitatus. | journal=J Infect Dis | year= 1990 | volume= 161 | issue= 5 | pages= 1041-2 | pmid=2324536 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2324536 }}</ref>
| | <div class="mw-collapsible mw-collapsed" id="mw-customcollapsible-x1"> |
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| *[[Paecilomyces]]<ref name="pmid12588483">{{cite journal| author=Kantarcioğlu AS, Hatemi G, Yücel A, De Hoog GS, Mandel NM| title=Paecilomyces variotii central nervous system infection in a patient with cancer. | journal=Mycoses | year= 2003 | volume= 46 | issue= 1-2 | pages= 45-50 | pmid=12588483 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12588483 }}</ref><ref name="pmid7192726">{{cite journal| author=Fagerburg R, Suh B, Buckley HR, Lorber B, Karian J| title=Cerebrospinal fluid shunt colonization and obstruction by Paecilomyces variotii. Case report. | journal=J Neurosurg | year= 1981 | volume= 54 | issue= 2 | pages= 257-60 | pmid=7192726 | doi=10.3171/jns.1981.54.2.0257 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7192726 }}</ref>
| | [[image:Passage-6.gif]] |
| | <br clear="left"/> |
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| *[[Aureobasidium]]<ref name="pmid22504065">{{cite journal| author=Kutleša M, Mlinarić-Missoni E, Hatvani L, Voncina D, Simon S, Lepur D et al.| title=Chronic fungal meningitis caused by Aureobasidium proteae. | journal=Diagn Microbiol Infect Dis | year= 2012 | volume= 73 | issue= 3 | pages= 271-2 | pmid=22504065 | doi=10.1016/j.diagmicrobio.2012.03.007 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22504065 }}</ref>
| | </div> |
| | |
| *Clavispora<ref name="pmid10030550">{{cite journal| author=Krcmery V, Mateicka F, Grausova S, Kunova A, Hanzen J| title=Invasive infections due to Clavispora lusitaniae. | journal=FEMS Immunol Med Microbiol | year= 1999 | volume= 23 | issue= 1 | pages= 75-8 | pmid=10030550 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10030550 }}</ref>
| |
| | |
| *[[Ustilago]]<ref name="pmid20991975">{{cite journal| author=MOORE M, RUSSELL WO, SACHS E| title=Chronic leptomeningitis and ependymitis caused by Ustilago, probably U. zeae (corn smut). | journal=Am J Pathol | year= 1946 | volume= 22 | issue= | pages= 761-77 | pmid=20991975 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20991975 }}</ref>
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| *[[Exophiala]] (Wangiella)<ref name="pmid12530707">{{cite journal| author=Centers for Disease Control and Prevention (CDC)| title=Exophiala infection from contaminated injectable steroids prepared by a compounding pharmacy--United States, July-November 2002. | journal=MMWR Morb Mortal Wkly Rep | year= 2002 | volume= 51 | issue= 49 | pages= 1109-12 | pmid=12530707 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12530707 }}</ref>
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| *Exserohilum<ref name="pmid23465119">{{cite journal| author=Pettit AC, Pugh ME| title=Index case for the fungal meningitis outbreak, United States. | journal=N Engl J Med | year= 2013 | volume= 368 | issue= 10 | pages= 970 | pmid=23465119 | doi=10.1056/NEJMc1300630 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23465119 }}</ref>
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| |style="padding: 5px 5px; background: #DCDCDC;" align="center" |Spirochetal
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| |style="padding: 5px 5px; background: #F5F5F5;" align="left" |
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| * [[Treponema pallidum]]
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| * [[Borrelia burgdorferi|Borrelia burgdoferi]]
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| |style="padding: 5px 5px; background: #F5F5F5;" align="left" | --
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| |-
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| |style="padding: 5px 5px; background: #DCDCDC;" align="center" |Protozoal and Helminthic
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| |style="padding: 5px 5px; background: #F5F5F5;" align="left" |
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| * Amebas (''[[Naegleria]], [[Acanthamoeba]],'' and ''[[Balamuthia mandrillaris|Balamuthia]])''
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| |style="padding: 5px 5px; background: #F5F5F5;" align="left" |
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| * [[Angiostrongylus cantonensis]]
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| * [[Gnathostoma Infection|Gnathostoma species]]
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| * [[Baylisascaris|Baylisascaris procyonis]]
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| * [[Toxocara|Toxocara species]]
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| * [[Taenia solium]]
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| |-
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| |style="padding: 5px 5px; background: #DCDCDC;" align="center" |Noninfectious conditions
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| |style="padding: 5px 5px; background: #F5F5F5;" align="left" |
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| * [[Neoplastic]]
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| * [[Sarcoidosis]]
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| * [[Systemic lupus erythematosus]]
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| * [[Granulomatosis with polyangiitis]] (Wegener's)
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| * [[Behçet's disease]]
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| |style="padding: 5px 5px; background: #F5F5F5;" align="left" |
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| * [[Fabry's disease|Fabry disease]]
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| * Central nervous system [[vasculitis]]
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| * [[Vogt-Koyanagi-Harada syndrome|Vogt-Koyanagi-Harada disease]]
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| * Chemical or drug-induced meningitis
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| ** [[Nonsteroidal antiinflammatory drugs]]
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| ** [[Intravenous immunoglobulin]]
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| ** [[Intrathecal]] agents
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| ** Certain antibiotics (eg, [[Sulfamethoxazole-Trimethoprim|trimethoprim-sulfamethoxazole]])
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| |}
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| <br>
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| |}
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| ==Classification==
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| Meningitis could be classified to two main groups based on etiology:
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| *Infectious
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| *Non-infectious
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| ===Infectious meningitis===
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| Infectious meningitis may be classified as the following algorithm based on chronicity of symptoms.<br><br>
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| {{familytree/start}}
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| {{familytree | | | | | | | | | | | | | | | A01 |A01='''Infectious Meningitis'''}}
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| {{familytree | | | | | |,|-|-|-|-|-|-|-|-|-|+|-|-|-|-|-|-|-|-|-|-|-|-|-|-|.| | | }}
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| {{familytree | | | | | B01 | | | | | | | | B02 | | | | | | | | | | | | | B03 | |B01=Viral|B02=Bacterial|B03=Fungal}}
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| {{familytree | | | | | | | | | | | |,|-|-|-|+|-|-|-|.| | | | |,|-|-|-|v|-|^|-|v|-|-|-|.|}}
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| {{familytree | | | | | | | | | | | C01 | | C02 | | C03 | | | C04 | | C05 | | C06 | | |C07 |C01=Acute|C02=Chronic|C03=Recurrent|C04=Acute|C05=Subacute|C06=Chronic|C07=Recurrent|}}
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| {{familytree/end}}<br>
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| ===Non-infectious meningitis===
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| Systemic illnesses, such as malignancies and connective tissue diseases (e.g. [[sarcoidosis]], [[SLE]], and [[Granulomatosis with polyangiitis|wegener's]]) may involve meninges in their course and present as chronic meningitis.
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| Certain drugs may cause meningeal irritation and resemble as meningitis including:
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| * [[Nonsteroidal antiinflammatory drugs]] (NSAIDs)
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| * [[Intravenous immunoglobulin]]
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| * [[Intrathecal]] agents
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| * Certain antibiotics (eg, [[Sulfamethoxazole-Trimethoprim|trimethoprim-sulfamethoxazole]])
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| | |
| ==Differential diagnosis==
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| {|
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| |-style="background: #4479BA; color: #FFFFFF; text-align: center;"
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| ! rowspan="2" |<small>Diseases</small>
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| ! colspan="4" |<small>Symptoms
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| ! colspan="5" |<small>Physical Examination</small>
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| ! rowspan="2" |<small>Past medical history</small>
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| ! colspan="3" |<small>Diagnostic tests</small>
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| ! rowspan="2" |<small>Other Findings</small>
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| |- style="background: #4479BA; color: #FFFFFF; text-align: center;"
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| !<small>Headache</small>
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| !↓<small>LOC</small>
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| !<small>Motor weakness</small>
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| !<small>Abnormal sensory</small>
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| !<small>Motor Deficit</small>
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| !<small>Sensory deficit</small>
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| !<small>Speech difficulty</small>
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| !<small>Gait abnormality</small>
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| !<small>Cranial nerves</small>
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| !<small>CT /MRI</small>
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| !<small>CSF Findings</small>
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| !<small>Gold standard test</small>
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| |-
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| | style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Meningitis]]
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| | style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| | style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| | style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| | style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| | style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| | style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| | style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| | style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| | style="background: #F5F5F5; padding: 5px text-align:center" | -
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| | style="background: #F5F5F5; padding: 5px text-align:center" |History of [[fever]] and [[malaise]]
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| | style="background: #F5F5F5; padding: 5px;" | -
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| | style="background: #F5F5F5; padding: 5px; text-align:center" |'''↑''' Leukocytes,
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| | |
| '''↑''' Protein
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| | |
| ↓ Glucose
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| | style="background: #F5F5F5; padding: 5px;" |[[CSF analysis]]<ref name="pmid19398286">{{cite journal| author=Carbonnelle E| title=[Laboratory diagnosis of bacterial meningitis: usefulness of various tests for the determination of the etiological agent]. | journal=Med Mal Infect | year= 2009 | volume= 39 | issue= 7-8 | pages= 581-605 | pmid=19398286 | doi=10.1016/j.medmal.2009.02.017 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19398286 }}</ref>
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| | style="background: #F5F5F5; padding: 5px;" |[[Fever]], [[Neck rigidity|neck]]
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| [[Neck rigidity|rigidity]]
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| |-
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| |Encephalitis
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| | +
| |
| | +
| |
| | +/-
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| | +/-
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| | -
| |
| | -
| |
| | +
| |
| | +/-
| |
| | +
| |
| |History of [[fever]] and [[malaise]]
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| | +
| |
| |'''↑''' Leukocytes, ↓ Glucose
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| |CSF PCR
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| |Fever, seizures, focal neurologic abnormalities
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| |-
| |
| |style="background: #DCDCDC; padding: 5px; text-align: center;" | [[Brain tumor]]<ref name="pmid10582668">{{cite journal| author=Morgenstern LB, Frankowski RF| title=Brain tumor masquerading as stroke. | journal=J Neurooncol | year= 1999 | volume= 44 | issue= 1 | pages= 47-52 | pmid=10582668 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10582668 }} </ref>
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
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| |style="background: #F5F5F5; padding: 5px text-align:center" | -
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| |style="background: #F5F5F5; padding: 5px text-align:center" | -
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| |style="background: #F5F5F5; padding: 5px text-align:center" | -
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| |style="background: #F5F5F5; padding: 5px text-align:center" | +
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| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |[[Weight loss]], [[fatigue]]
| |
| |style="background: #F5F5F5; padding: 5px; text-align:center"| +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |Cancer cells<ref name="pmid21371327">{{cite journal| author=Weston CL, Glantz MJ, Connor JR| title=Detection of cancer cells in the cerebrospinal fluid: current methods and future directions. | journal=Fluids Barriers CNS | year= 2011 | volume= 8 | issue= 1 | pages= 14 | pmid=21371327 | doi=10.1186/2045-8118-8-14 | pmc=3059292 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21371327 }}</ref>
| |
| |style="background: #F5F5F5; padding: 5px;" |MRI
| |
| |style="background: #F5F5F5; padding: 5px;" |[[Cachexia]], gradual progression of symptoms
| |
| |-
| |
| |style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Hemorrhagic stroke]]
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |[[Hypertension]]
| |
| |style="background: #F5F5F5; padding: 5px; text-align:center" | +
| |
| | style="background: #F5F5F5; padding: 5px;" | -
| |
| |style="background: #F5F5F5; padding: 5px;" |CT scan without contrast<ref name="pmid21694755">{{cite journal| author=Birenbaum D, Bancroft LW, Felsberg GJ| title=Imaging in acute stroke. | journal=West J Emerg Med | year= 2011 | volume= 12 | issue= 1 | pages= 67-76 | pmid=21694755 | doi= | pmc=3088377 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21694755 }}</ref><ref name="pmid21807345">{{cite journal| author=DeLaPaz RL, Wippold FJ, Cornelius RS, Amin-Hanjani S, Angtuaco EJ, Broderick DF et al.| title=ACR Appropriateness Criteria® on cerebrovascular disease. | journal=J Am Coll Radiol | year= 2011 | volume= 8 | issue= 8 | pages= 532-8 | pmid=21807345 | doi=10.1016/j.jacr.2011.05.010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21807345 }}</ref>
| |
| |style="background: #F5F5F5; padding: 5px;" |[[Neck stiffness]]
| |
| |-
| |
| |style="background: #DCDCDC; padding: 5px; text-align: center;" | [[Subdural hematoma|Subdural hemorrhage]]
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |[[Trauma]], fall
| |
| |style="background: #F5F5F5; padding: 5px; text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px;" |Xanthochromia<ref name="pmid1198628">{{cite journal| author=Lee MC, Heaney LM, Jacobson RL, Klassen AC| title=Cerebrospinal fluid in cerebral hemorrhage and infarction. | journal=Stroke | year= 1975 | volume= 6 | issue= 6 | pages= 638-41 | pmid=1198628 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1198628 }}</ref>
| |
| |style="background: #F5F5F5; padding: 5px;" |CT scan without contrast<ref name="pmid21694755">{{cite journal| author=Birenbaum D, Bancroft LW, Felsberg GJ| title=Imaging in acute stroke. | journal=West J Emerg Med | year= 2011 | volume= 12 | issue= 1 | pages= 67-76 | pmid=21694755 | doi= | pmc=3088377 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21694755 }}</ref><ref name="pmid21807345">{{cite journal| author=DeLaPaz RL, Wippold FJ, Cornelius RS, Amin-Hanjani S, Angtuaco EJ, Broderick DF et al.| title=ACR Appropriateness Criteria® on cerebrovascular disease. | journal=J Am Coll Radiol | year= 2011 | volume= 8 | issue= 8 | pages= 532-8 | pmid=21807345 | doi=10.1016/j.jacr.2011.05.010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21807345 }}</ref>
| |
| |style="background: #F5F5F5; padding: 5px;" |[[Confusion]], [[dizziness]], [[nausea]], [[vomiting]]
| |
| |-
| |
| |style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Neurosyphilis]]<ref name="pmid22482824">{{cite journal| author=Liu LL, Zheng WH, Tong ML, Liu GL, Zhang HL, Fu ZG et al.| title=Ischemic stroke as a primary symptom of neurosyphilis among HIV-negative emergency patients. | journal=J Neurol Sci | year= 2012 | volume= 317 | issue= 1-2 | pages= 35-9 | pmid=22482824 | doi=10.1016/j.jns.2012.03.003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22482824 }} </ref><ref name="pmid24365430">{{cite journal |vauthors=Berger JR, Dean D |title=Neurosyphilis |journal=Handb Clin Neurol |volume=121 |issue= |pages=1461–72 |year=2014 |pmid=24365430 |doi=10.1016/B978-0-7020-4088-7.00098-5 |url=}}</ref>
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |[[Sexually transmitted disease|STI]]<nowiki/>s
| |
| |style="background: #F5F5F5; padding: 5px; text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px;" |'''↑''' [[Leukocytes]] and [[protein]]
| |
| |style="background: #F5F5F5; padding: 5px;" |CSF [[VDRL]]-specifc
| |
| CSF FTA-Ab -sensitive<ref name="pmid22421697">{{cite journal| author=Ho EL, Marra CM| title=Treponemal tests for neurosyphilis--less accurate than what we thought? | journal=Sex Transm Dis | year= 2012 | volume= 39 | issue= 4 | pages= 298-9 | pmid=22421697 | doi=10.1097/OLQ.0b013e31824ee574 | pmc=3746559 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22421697 }}</ref>
| |
| |style="background: #F5F5F5; padding: 5px;" |[[Blindness]], [[confusion]], [[depression]],
| |
| | |
| Abnormal [[gait]]
| |
| |-
| |
| |style="background: #DCDCDC; padding: 5px; text-align: center;" |Complex or atypical [[migraine]]
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |Family history of [[migraine]]
| |
| | style="background: #F5F5F5; padding: 5px;" | -
| |
| | style="background: #F5F5F5; padding: 5px;" | -
| |
| |style="background: #F5F5F5; padding: 5px;" |Clinical assesment
| |
| |style="background: #F5F5F5; padding: 5px;" |Presence of aura, [[nausea]], [[vomiting]]
| |
| |-
| |
| |style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Hypertensive encephalopathy]]
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |[[Hypertension]]
| |
| |style="background: #F5F5F5; padding: 5px;" | +
| |
| |style="background: #F5F5F5; padding: 5px;" | -
| |
| |style="background: #F5F5F5; padding: 5px;" |Clinical assesment
| |
| |style="background: #F5F5F5; padding: 5px;" |[[Delirium]], [[cortical blindness]], [[cerebral edema]], [[seizure]]
| |
| |-
| |
| |style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Wernicke's encephalopathy|Wernicke’s encephalopathy]]
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |History of alcohal abuse
| |
| | style="background: #F5F5F5; padding: 5px;" | -
| |
| | style="background: #F5F5F5; padding: 5px;" | -
| |
| | style="background: #F5F5F5; padding: 5px;" |Clinical assesment and lab findings
| |
| |style="background: #F5F5F5; padding: 5px;" |[[Ophthalmoplegia]], [[confusion]]
| |
| |-
| |
| |style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Brain abscess|CNS abscess]]
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |History of [[drug abuse]], [[endocarditis]], [[immunosupression]]
| |
| |style="background: #F5F5F5; padding: 5px;" | +
| |
| |style="background: #F5F5F5; padding: 5px;" |'''↑''' leukocytes, '''↓''' glucose and '''↑''' protien
| |
| |style="background: #F5F5F5; padding: 5px;" |MRI is more sensitive and specific
| |
| |style="background: #F5F5F5; padding: 5px;" |High grade [[fever]], [[fatigue]],[[nausea]], [[vomiting]]
| |
| |-
| |
| |style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Drug toxicity]]
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| | style="background: #F5F5F5; padding: 5px;" | -
| |
| | style="background: #F5F5F5; padding: 5px;" | -
| |
| | style="background: #F5F5F5; padding: 5px;" |Drug screen test
| |
| |style="background: #F5F5F5; padding: 5px;" |[[Lithium]], [[Sedatives]], [[phenytoin]], [[carbamazepine]]
| |
| |-
| |
| |style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Conversion disorder]]
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |History of [[emotional stress]]
| |
| | style="background: #F5F5F5; padding: 5px;" | -
| |
| | style="background: #F5F5F5; padding: 5px;" | -
| |
| |style="background: #F5F5F5; padding: 5px;" |Diagnosis of exclusion
| |
| |style="background: #F5F5F5; padding: 5px;" |[[Tremor|Tremors]], [[blindness]], difficulty [[swallowing]]
| |
| |-
| |
| |style="background: #DCDCDC; padding: 5px; text-align: center;" |Metabolic disturbances ([[electrolyte imbalance]], [[hypoglycemia]])
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| | style="background: #F5F5F5; padding: 5px;" | -
| |
| | style="background: #F5F5F5; padding: 5px;" |[[Hypoglycemia]], [[Hyponatremia|hypo]] and [[hypernatremia]], [[Hypokalemia|hypo]] and [[hyperkalemia]]
| |
| |style="background: #F5F5F5; padding: 5px;" |Depends on the cause
| |
| | style="background: #F5F5F5; padding: 5px;" |[[Confusion]], [[seizure]], [[Palpitation|palpitations]], [[sweating]], [[dizziness]], [[hypoglycemia]]
| |
| |-
| |
| | style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Multiple sclerosis]] exacerbation
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |History of relapses and remissions
| |
| | style="background: #F5F5F5; padding: 5px; text-align:center" | +
| |
| | style="background: #F5F5F5; padding: 5px; text-align:center" |'''↑''' CSF IgG levels
| |
| (monoclonal bands)
| |
| | style="background: #F5F5F5; padding: 5px;" |Clinical assesment and [[MRI]] <ref name="pmid8274111">{{cite journal| author=Giang DW, Grow VM, Mooney C, Mushlin AI, Goodman AD, Mattson DH et al.| title=Clinical diagnosis of multiple sclerosis. The impact of magnetic resonance imaging and ancillary testing. Rochester-Toronto Magnetic Resonance Study Group. | journal=Arch Neurol | year= 1994 | volume= 51 | issue= 1 | pages= 61-6 | pmid=8274111 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8274111 }}</ref>
| |
| | style="background: #F5F5F5; padding: 5px;" |[[Blurred vision|Blurry vision]], [[urinary incontinence]], [[fatigue]]
| |
| |-
| |
| | style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Seizure]]
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |Previous history of [[seizures]]
| |
| | style="background: #F5F5F5; padding: 5px;" | -
| |
| | style="background: #F5F5F5; padding: 5px;" |Mass lesion
| |
| | style="background: #F5F5F5; padding: 5px;" |Clinical assesment and [[EEG]] <ref name="pmid11385043">{{cite journal| author=Manford M| title=Assessment and investigation of possible epileptic seizures. | journal=J Neurol Neurosurg Psychiatry | year= 2001 | volume= 70 Suppl 2 | issue= | pages= II3-8 | pmid=11385043 | doi= | pmc=1765557 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11385043 }}</ref>
| |
| | style="background: #F5F5F5; padding: 5px;" |[[Confusion]], [[apathy]], [[irritability]],
| |
| |}
| |
| | |
| ==Diagnosis==
| |
| | |
| ==References==
| |
| {{reflist|2}}
| |
