Ischemic stroke differential diagnosis: Difference between revisions

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Latest revision as of 05:04, 30 August 2023

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Maryam Hadipour, M.D.[2],Aysha Anwar, M.B.B.S [3]

Overview

The differential diagnosis of ischemic stroke may include brain tumor, hemorrhagic stroke, subdural hemorrhage, neurosyphilis, complex or atypical migraine, hypertensive encephalopathy, Wernicke’s encephalopathy, CNS abscess, drug toxicity, conversion disorder, electrolyte disturbance, meningitis or encephalitis, multiple sclerosis exacerbation, seizure and hypoglycemia. There are also some conditions which may cause muscle weakness and paralysis such as Botulism, Myasthenia gravis, Guillian-Barre syndrome, Eaton Lambert syndrome, Electrolyte disturbance, Organophosphate toxicity, Multiple sclerosis exacerbation, Amyotrophic lateral sclerosis, Inflammatory myopathy. It is necessary to differentiate these conditions from stroke.

Differential Diagnosis

Stroke, must be differentiated from other diseases that may cause, altered mental status, motor and or somatosensory deficits. The table below, summarizes the differential diagnosis for stroke:^[1]^[2]^[3]^[4]^[5]^[4]^[5]^[6]^[7]^[8]^[9]^[10]^[11]

Diseases	Diagnostic tests				Physical Examination					Symptoms				Past medical history	Other Findings
Diseases	Na+, K+, Ca2+	CT /MRI	CSF Findings	Gold standard test	Motor Deficit	Sensory deficit	Speech difficulty	Gait abnormality	Cranial nerves	Headache	LOC	Motor weakness	Abnormal sensations		Other Findings
Brain tumour^[1]		✔	Cancer cells^[2]	MRI	✔	✔	✔	✔	✔	✔					Cachexia, gradual progression of symptoms
Hemorrhagic stroke		✔	Xanthochromia^[3]	CT scan without contrast^[4]^[5]	✔	✔	✔	✔	✔	✔	✔	✔		Hypertension	Neck stiffness
Subdural hemorrhage		✔		CT scan without contrast^[4]^[5]	✔	✔	✔	✔	✔	✔	✔	✔		Trauma/fall	Confusion, dizziness, nausea, vomiting
Neurosyphilis^[6]^[7]		✔	↑ Leukocytes and protein	CSF VDRL-specifc CSF FTA-Ab -sensitive^[8]	✔	✔	✔	✔		✔		✔	✔	STIs	Blindness, confusion, depression, Abnormal gait
Complex or atypical migraine				Clinical assesment			✔			✔			✔	Family history of migraine	Presence of aura, nausea, vomiting
Hypertensive encephalopathy		✔		Clinical assesment			✔	✔	✔	✔	✔			History of hypertension	Delirium, cortical blindness, cerebral edema, seizure
Wernicke’s encephalopathy							✔	✔			✔			History of alcohal abuse	Ophthalmoplegia, confusion
CNS abscess		✔	↑ leukocytes, ↓ glucose and ↑ protien	MRI is more sensitive and specific	✔	✔	✔			✔	✔			History of drug abuse, endocarditis, ↓ immune status	High grade fever, fatigue,nausea, vomiting
Drug toxicity							✔	✔			✔				Lithium, Sedatives, phenytoin, carbamazepine
Conversion disorder				Diagnosis of exclusion	✔	✔	✔	✔		✔	✔	✔	✔		Tremors, blindness, difficulty swallowing
Electrolyte disturbance	↓ or ↑			Depends on the cause											Confusion, seizures
Meningitis or encephalitis			↑ Leukocytes, ↑ Protein ↓ Glucose	CSF analysis^[9]					✔	✔					Fever, neck rigidity
Multiple sclerosis exacerbation		✔	↑ CSF IgG levels (monoclonal bands)	Clinical assesment and MRI ^[10]	✔	✔	✔	✔	✔			✔	✔	History of relapses and remissions	Blurry vision, urinary incontinence, fatigue
Seizure	↓ or ↑			Clinical assesment and EEG ^[11]	✔					✔	✔		✔	Previous history of seizures	Confusion, apathy, irritability,
Hypoglycemia	↓ or ↑			Serum blood glucose HbA1c			✔	✔		✔	✔		✔	History of diabetes	Palpitations, sweating, dizziness, low serum, glucose

Stroke should be differentiated from other causes of muscle weakness and paralysis. The differentials include the following:

Diseases	History and Physical								Diagnostic tests		Other Findings
Diseases	Motor Deficit	Sensory deficit	Cranial nerve Involvement	Autonomic dysfunction	Proximal/Distal/Generalized	Ascending/Descending/Systemic	Unilateral (UL) or Bilateral (BL) or No Lateralization (NL)	Onset	Lab or Imaging Findings	Specific test	Other Findings
Adult Botulism	+	-	+	+	Generalized	Descending	BL	Sudden	Toxin test	Blood, Wound, or Stool culture	Diplopia, Hyporeflexia, Hypotonia, possible respiratory paralysis
Infant Botulism	+	-	+	+	Generalized	Descending	BL	Sudden	Toxin test	Blood, Wound, or Stool culture	Flaccid paralysis (Floppy baby syndrome), possible respiratory paralysis
Guillian-Barre syndrome^[12]	+	-	-	-	Generalized	Ascending	BL	Insidious	CSF: ↑Protein ↓Cells	Clinical & Lumbar Puncture	Progressive ascending paralysis following infection, possible respiratory paralysis
Eaton Lambert syndrome^[13]	+	-	+	+	Generalized	Systemic	BL	Intermittent	EMG, repetitive nerve stimulation test (RNS)	Voltage gated calcium channel (VGCC) antibody	Diplopia, ptosis, improves with movement (as the day progresses)
Myasthenia gravis^[14]	+	-	+	+	Generalized	Systemic	BL	Intermittent	EMG, Edrophonium test	Ach receptor antibody	Diplopia, ptosis, worsening with movement (as the day progresses)
Electrolyte disturbance^[15]	+	+	-	-	Generalized	Systemic	BL	Insidious	Electrolyte panel	↓Ca++, ↓Mg++, ↓K+	Possible arrhythmia
Organophosphate toxicity^[16]	+	+	-	+	Generalized	Ascending	BL	Sudden	Clinical diagnosis: physical exam & history	Clinical suspicion confirmed with RBC AchE activity	History of exposure to insecticide or living in farming environment. with : Diarrhea, Urination, Miosis, Bradycardia, Lacrimation, Emesis, Salivation, Sweating
Tick paralysis (Dermacentor tick)^[17]	+	-	-	-	Generalized	Ascending	BL	Insidious	Clinical diagnosis: physical exam & history	-	History of outdoor activity in Northeastern United States. The tick is often still latched to the patient at presentation (often in head and neck area)
Tetrodotoxin poisoning^[18]	+	-	+	+	Generalized	Systemic	BL	Sudden	Clinical diagnosis: physical exam & dietary history	-	History of consumption of puffer fish species.
Stroke^[19]	+/-	+/-	+/-	+/-	Generalized	Systemic	UL	Sudden	MRI +ve for ischemia or hemorrhage	MRI	Sudden unilateral motor and sensory deficit in a patient with a history of atherosclerotic risk factors (diabetes, hypertension, smoking) or atrial fibrillation.
Poliomyelitis^[20]	+	+	+	+/-	Proximal > Distal	Systemic	BL or UL	Sudden		PCR of CSF	Asymmetric paralysis following a flu-like syndrome.
Transverse myelitis^[21]	+	+	+	+	Proximal > Distal	Systemic	BL or UL	Sudden	MRI & Lumbar puncture	MRI	History of chronic viral or autoimmune disease (e.g. HIV)
Neurosyphilis^[6]^[7]	+	+	-	+/-	Generalized	Systemic	BL	Insidious	MRI & Lumbar puncture	CSF VDRL-specifc CSF FTA-Ab -sensitive^[8]	History of unprotected sex or multiple sexual partners. History of genital ulcer (chancre), diffuse maculopapular rash.
Muscular dystrophy^[22]	+	-	-	-	Proximal > Distal	Systemic	BL	Insidious	Genetic testing	Muscle biopsy	Progressive proximal lower limb weakness with calf pseudohypertrophy in early childhood. Gower sign positive.
Multiple sclerosis exacerbation^[23]	+	+	+	+	Generalized	Systemic	NL	Sudden	↑CSF IgG levels (monoclonal)	Clinical assessment and MRI ^[10]	Blurry vision, urinary incontinence, fatigue
Amyotrophic lateral sclerosis^[24]	+	-	-	-	Generalized	Systemic	BL	Insidious	Normal LP (to rule out DDx)	MRI & LP	Patient initially presents with upper motor neuron deficit (spasticity) followed by lower motor neuron deficit (flaccidity).
Inflammatory myopathy^[25]	+	-	-	-	Proximal > Distal	Systemic	UL or BL	Insidious	Elevated CK & Aldolase	Muscle biopsy	Progressive proximal muscle weakness in 3rd to 5th decade of life. With or without skin manifestations.

References

↑ ^1.0 ^1.1 Morgenstern LB, Frankowski RF (1999). "Brain tumor masquerading as stroke". J Neurooncol. 44 (1): 47–52. PMID 10582668.
↑ ^2.0 ^2.1 Weston CL, Glantz MJ, Connor JR (2011). "Detection of cancer cells in the cerebrospinal fluid: current methods and future directions". Fluids Barriers CNS. 8 (1): 14. doi:10.1186/2045-8118-8-14. PMC 3059292. PMID 21371327.
↑ ^3.0 ^3.1 Lee MC, Heaney LM, Jacobson RL, Klassen AC (1975). "Cerebrospinal fluid in cerebral hemorrhage and infarction". Stroke. 6 (6): 638–41. PMID 1198628.
↑ ^4.0 ^4.1 ^4.2 ^4.3 Birenbaum D, Bancroft LW, Felsberg GJ (2011). "Imaging in acute stroke". West J Emerg Med. 12 (1): 67–76. PMC 3088377. PMID 21694755.
↑ ^5.0 ^5.1 ^5.2 ^5.3 DeLaPaz RL, Wippold FJ, Cornelius RS, Amin-Hanjani S, Angtuaco EJ, Broderick DF; et al. (2011). "ACR Appropriateness Criteria® on cerebrovascular disease". J Am Coll Radiol. 8 (8): 532–8. doi:10.1016/j.jacr.2011.05.010. PMID 21807345.
↑ ^6.0 ^6.1 ^6.2 Liu LL, Zheng WH, Tong ML, Liu GL, Zhang HL, Fu ZG; et al. (2012). "Ischemic stroke as a primary symptom of neurosyphilis among HIV-negative emergency patients". J Neurol Sci. 317 (1–2): 35–9. doi:10.1016/j.jns.2012.03.003. PMID 22482824.
↑ ^7.0 ^7.1 ^7.2 Berger JR, Dean D (2014). "Neurosyphilis". Handb Clin Neurol. 121: 1461–72. doi:10.1016/B978-0-7020-4088-7.00098-5. PMID 24365430.
↑ ^8.0 ^8.1 ^8.2 Ho EL, Marra CM (2012). "Treponemal tests for neurosyphilis--less accurate than what we thought?". Sex Transm Dis. 39 (4): 298–9. doi:10.1097/OLQ.0b013e31824ee574. PMC 3746559. PMID 22421697.
↑ ^9.0 ^9.1 Carbonnelle E (2009). "[Laboratory diagnosis of bacterial meningitis: usefulness of various tests for the determination of the etiological agent]". Med Mal Infect. 39 (7–8): 581–605. doi:10.1016/j.medmal.2009.02.017. PMID 19398286.
↑ ^10.0 ^10.1 ^10.2 Giang DW, Grow VM, Mooney C, Mushlin AI, Goodman AD, Mattson DH; et al. (1994). "Clinical diagnosis of multiple sclerosis. The impact of magnetic resonance imaging and ancillary testing. Rochester-Toronto Magnetic Resonance Study Group". Arch Neurol. 51 (1): 61–6. PMID 8274111.
↑ ^11.0 ^11.1 Manford M (2001). "Assessment and investigation of possible epileptic seizures". J Neurol Neurosurg Psychiatry. 70 Suppl 2: II3–8. PMC 1765557. PMID 11385043.
↑ Talukder RK, Sutradhar SR, Rahman KM, Uddin MJ, Akhter H (2011). "Guillian-Barre syndrome". Mymensingh Med J. 20 (4): 748–56. PMID 22081202.
↑ Merino-Ramírez MÁ, Bolton CF (2016). "Review of the Diagnostic Challenges of Lambert-Eaton Syndrome Revealed Through Three Case Reports". Can J Neurol Sci. 43 (5): 635–47. doi:10.1017/cjn.2016.268. PMID 27412406.
↑ Gilhus NE (2016). "Myasthenia Gravis". N Engl J Med. 375 (26): 2570–2581. doi:10.1056/NEJMra1602678. PMID 28029925.
↑ Ozono K (2016). "[Diagnostic criteria for vitamin D-deficient rickets and hypocalcemia-]". Clin Calcium. 26 (2): 215–22. doi:CliCa1602215222 Check |doi= value (help). PMID 26813501.
↑ Kamanyire R, Karalliedde L (2004). "Organophosphate toxicity and occupational exposure". Occup Med (Lond). 54 (2): 69–75. PMID 15020723.
↑ Pecina CA (2012). "Tick paralysis". Semin Neurol. 32 (5): 531–2. doi:10.1055/s-0033-1334474. PMID 23677663.
↑ Bane V, Lehane M, Dikshit M, O'Riordan A, Furey A (2014). "Tetrodotoxin: chemistry, toxicity, source, distribution and detection". Toxins (Basel). 6 (2): 693–755. doi:10.3390/toxins6020693. PMC 3942760. PMID 24566728.
↑ Kuntzer T, Hirt L, Bogousslavsky J (1996). "[Neuromuscular involvement and cerebrovascular accidents]". Rev Med Suisse Romande. 116 (8): 605–9. PMID 8848683.
↑ Laffont I, Julia M, Tiffreau V, Yelnik A, Herisson C, Pelissier J (2010). "Aging and sequelae of poliomyelitis". Ann Phys Rehabil Med. 53 (1): 24–33. doi:10.1016/j.rehab.2009.10.002. PMID 19944665.
↑ West TW (2013). "Transverse myelitis--a review of the presentation, diagnosis, and initial management". Discov Med. 16 (88): 167–77. PMID 24099672.
↑ Falzarano MS, Scotton C, Passarelli C, Ferlini A (2015). "Duchenne Muscular Dystrophy: From Diagnosis to Therapy". Molecules. 20 (10): 18168–84. doi:10.3390/molecules201018168. PMID 26457695.
↑ Filippi M, Preziosa P, Rocca MA (2016). "Multiple sclerosis". Handb Clin Neurol. 135: 399–423. doi:10.1016/B978-0-444-53485-9.00020-9. PMID 27432676.
↑ Riva N, Agosta F, Lunetta C, Filippi M, Quattrini A (2016). "Recent advances in amyotrophic lateral sclerosis". J Neurol. 263 (6): 1241–54. doi:10.1007/s00415-016-8091-6. PMC 4893385. PMID 27025851.
↑ Michelle EH, Mammen AL (2015). "Myositis Mimics". Curr Rheumatol Rep. 17 (10): 63. doi:10.1007/s11926-015-0541-0. PMID 26290112.

Template:WikiDoc Sources

[pmid10582668-1] 1.0 ^1.1 Morgenstern LB, Frankowski RF (1999). "Brain tumor masquerading as stroke". J Neurooncol. 44 (1): 47–52. PMID 10582668.

[pmid21371327-2] 2.0 ^2.1 Weston CL, Glantz MJ, Connor JR (2011). "Detection of cancer cells in the cerebrospinal fluid: current methods and future directions". Fluids Barriers CNS. 8 (1): 14. doi:10.1186/2045-8118-8-14. PMC 3059292. PMID 21371327.

[pmid1198628-3] 3.0 ^3.1 Lee MC, Heaney LM, Jacobson RL, Klassen AC (1975). "Cerebrospinal fluid in cerebral hemorrhage and infarction". Stroke. 6 (6): 638–41. PMID 1198628.

[pmid21694755-4] 4.0 ^4.1 ^4.2 ^4.3 Birenbaum D, Bancroft LW, Felsberg GJ (2011). "Imaging in acute stroke". West J Emerg Med. 12 (1): 67–76. PMC 3088377. PMID 21694755.

[pmid21807345-5] 5.0 ^5.1 ^5.2 ^5.3 DeLaPaz RL, Wippold FJ, Cornelius RS, Amin-Hanjani S, Angtuaco EJ, Broderick DF; et al. (2011). "ACR Appropriateness Criteria® on cerebrovascular disease". J Am Coll Radiol. 8 (8): 532–8. doi:10.1016/j.jacr.2011.05.010. PMID 21807345.

[pmid22482824-6] 6.0 ^6.1 ^6.2 Liu LL, Zheng WH, Tong ML, Liu GL, Zhang HL, Fu ZG; et al. (2012). "Ischemic stroke as a primary symptom of neurosyphilis among HIV-negative emergency patients". J Neurol Sci. 317 (1–2): 35–9. doi:10.1016/j.jns.2012.03.003. PMID 22482824.

[pmid24365430-7] 7.0 ^7.1 ^7.2 Berger JR, Dean D (2014). "Neurosyphilis". Handb Clin Neurol. 121: 1461–72. doi:10.1016/B978-0-7020-4088-7.00098-5. PMID 24365430.

[pmid22421697-8] 8.0 ^8.1 ^8.2 Ho EL, Marra CM (2012). "Treponemal tests for neurosyphilis--less accurate than what we thought?". Sex Transm Dis. 39 (4): 298–9. doi:10.1097/OLQ.0b013e31824ee574. PMC 3746559. PMID 22421697.

[pmid19398286-9] 9.0 ^9.1 Carbonnelle E (2009). "[Laboratory diagnosis of bacterial meningitis: usefulness of various tests for the determination of the etiological agent]". Med Mal Infect. 39 (7–8): 581–605. doi:10.1016/j.medmal.2009.02.017. PMID 19398286.

[pmid8274111-10] 10.0 ^10.1 ^10.2 Giang DW, Grow VM, Mooney C, Mushlin AI, Goodman AD, Mattson DH; et al. (1994). "Clinical diagnosis of multiple sclerosis. The impact of magnetic resonance imaging and ancillary testing. Rochester-Toronto Magnetic Resonance Study Group". Arch Neurol. 51 (1): 61–6. PMID 8274111.

[pmid11385043-11] 11.0 ^11.1 Manford M (2001). "Assessment and investigation of possible epileptic seizures". J Neurol Neurosurg Psychiatry. 70 Suppl 2: II3–8. PMC 1765557. PMID 11385043.

[pmid22081202-12] Talukder RK, Sutradhar SR, Rahman KM, Uddin MJ, Akhter H (2011). "Guillian-Barre syndrome". Mymensingh Med J. 20 (4): 748–56. PMID 22081202.

[pmid27412406-13] Merino-Ramírez MÁ, Bolton CF (2016). "Review of the Diagnostic Challenges of Lambert-Eaton Syndrome Revealed Through Three Case Reports". Can J Neurol Sci. 43 (5): 635–47. doi:10.1017/cjn.2016.268. PMID 27412406.

[pmid28029925-14] Gilhus NE (2016). "Myasthenia Gravis". N Engl J Med. 375 (26): 2570–2581. doi:10.1056/NEJMra1602678. PMID 28029925.

[pmid26813501-15] Ozono K (2016). "[Diagnostic criteria for vitamin D-deficient rickets and hypocalcemia-]". Clin Calcium. 26 (2): 215–22. doi:CliCa1602215222 Check |doi= value (help). PMID 26813501.

[pmid15020723-16] Kamanyire R, Karalliedde L (2004). "Organophosphate toxicity and occupational exposure". Occup Med (Lond). 54 (2): 69–75. PMID 15020723.

[pmid23677663-17] Pecina CA (2012). "Tick paralysis". Semin Neurol. 32 (5): 531–2. doi:10.1055/s-0033-1334474. PMID 23677663.

[pmid24566728-18] Bane V, Lehane M, Dikshit M, O'Riordan A, Furey A (2014). "Tetrodotoxin: chemistry, toxicity, source, distribution and detection". Toxins (Basel). 6 (2): 693–755. doi:10.3390/toxins6020693. PMC 3942760. PMID 24566728.

[pmid8848683-19] Kuntzer T, Hirt L, Bogousslavsky J (1996). "[Neuromuscular involvement and cerebrovascular accidents]". Rev Med Suisse Romande. 116 (8): 605–9. PMID 8848683.

[pmid19944665-20] Laffont I, Julia M, Tiffreau V, Yelnik A, Herisson C, Pelissier J (2010). "Aging and sequelae of poliomyelitis". Ann Phys Rehabil Med. 53 (1): 24–33. doi:10.1016/j.rehab.2009.10.002. PMID 19944665.

[pmid24099672-21] West TW (2013). "Transverse myelitis--a review of the presentation, diagnosis, and initial management". Discov Med. 16 (88): 167–77. PMID 24099672.

[pmid26457695-22] Falzarano MS, Scotton C, Passarelli C, Ferlini A (2015). "Duchenne Muscular Dystrophy: From Diagnosis to Therapy". Molecules. 20 (10): 18168–84. doi:10.3390/molecules201018168. PMID 26457695.

[pmid27432676-23] Filippi M, Preziosa P, Rocca MA (2016). "Multiple sclerosis". Handb Clin Neurol. 135: 399–423. doi:10.1016/B978-0-444-53485-9.00020-9. PMID 27432676.

[pmid27025851-24] Riva N, Agosta F, Lunetta C, Filippi M, Quattrini A (2016). "Recent advances in amyotrophic lateral sclerosis". J Neurol. 263 (6): 1241–54. doi:10.1007/s00415-016-8091-6. PMC 4893385. PMID 27025851.

[pmid26290112-25] Michelle EH, Mammen AL (2015). "Myositis Mimics". Curr Rheumatol Rep. 17 (10): 63. doi:10.1007/s11926-015-0541-0. PMID 26290112.

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@@ Line 1: / Line 1: @@
 __NOTOC__
-Please help WikiDoc by adding content here.  It's easy!  Click  [[Help:How_to_Edit_a_Page|here]]  to learn about editing.
 {{Stroke}}
+{{CMG}}{{AE}} {{MHP}},{{AA}}
+==Overview==
+The differential diagnosis of [[ischemic]] stroke may include brain [[tumor]], [[hemorrhagic stroke]], [[subdural hemorrhage]], [[neurosyphilis]], complex or atypical [[migraine]], [[hypertensive encephalopathy]], [[Wernicke’s encephalopathy]], [[CNS abscess]], drug toxicity, conversion disorder, electrolyte disturbance, [[meningitis]] or [[encephalitis]], multiple sclerosis exacerbation, [[seizure]] and [[hypoglycemia]].
+There are also some conditions which may cause muscle weakness and paralysis such as [[Botulism]], [[Myasthenia gravis]], [[Guillian-Barre syndrome]], Eaton Lambert syndrome, Electrolyte disturbance, Organophosphate toxicity, Multiple sclerosis exacerbation, [[Amyotrophic lateral sclerosis]], [[Inflammatory myopathy]]. It is necessary to differentiate these conditions from stroke.
+==Differential Diagnosis==
+Stroke, must be differentiated from other diseases that may cause, altered mental status, motor and or somatosensory deficits. The table below, summarizes the differential diagnosis for stroke:<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><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><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><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><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><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><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><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><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><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: #4479BA; color: #FFFFFF; text-align: center;"
+! rowspan="2" |<small>Diseases</small>
+! colspan="4" |<small>Diagnostic tests</small>
+! colspan="5" |<small>Physical Examination</small>
+! colspan="4" |<small>Symptoms
+! colspan="1" |<small>Past medical history</small>
+! rowspan="2" |<small>Other Findings</small>
+|-style="background: #4479BA; color: #FFFFFF; text-align: center;"
+!<small>Na+, K+, Ca2+</small>
+!<small>CT /MRI</small>
+!<small>CSF Findings</small>
+!<small>Gold standard test</small>
+!<small>Motor Deficit</small>
+!<small>Sensory deficit</small>
+!<small>Speech difficulty</small>
+!<small>Gait abnormality</small>
+!<small>Cranial nerves</small>
+!<small>Headache</small>
+!<small>LOC</small>
+!<small>Motor weakness</small>
+!<small>Abnormal sensations</small>
+!
+|-
+|style="background: #DCDCDC; padding: 5px; text-align: center;" | Brain tumour<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;" |
+|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; 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;" |
+|style="background: #F5F5F5; padding: 5px;" |
+|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;" |
+|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; 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;" |[[Hypertension]]
+|style="background: #F5F5F5; padding: 5px;" |Neck stiffness
+|-
+|style="background: #DCDCDC; padding: 5px; text-align: center;" | Subdural hemorrhage
+|style="background: #F5F5F5; padding: 5px;" |
+|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; 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;" |Trauma/fall
+|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;" |
+|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; 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; text-align:center" |✔
+|style="background: #F5F5F5; padding: 5px;" |
+|style="background: #F5F5F5; padding: 5px; text-align:center" |✔
+|style="background: #F5F5F5; padding: 5px; text-align:center" |✔
+|style="background: #F5F5F5; padding: 5px;" |STIs
+|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;" |
+|style="background: #F5F5F5; padding: 5px;" |
+|style="background: #F5F5F5; padding: 5px;" |
+|style="background: #F5F5F5; padding: 5px;" |Clinical assesment
+|style="background: #F5F5F5; padding: 5px;" |
+|style="background: #F5F5F5; padding: 5px;" |
+|style="background: #F5F5F5; padding: 5px;text-align:center" |✔
+|style="background: #F5F5F5; padding: 5px;" |
+| style="background: #F5F5F5; padding: 5px;" |
+|style="background: #F5F5F5; padding: 5px; text-align:center" |✔
+|style="background: #F5F5F5; padding: 5px;" |
+|style="background: #F5F5F5; padding: 5px;" |
+|style="background: #F5F5F5; padding: 5px; text-align:center" |✔
+|style="background: #F5F5F5; padding: 5px;" |Family history of [[migraine]]
+|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;" |
+|style="background: #F5F5F5; padding: 5px;" |✔
+|style="background: #F5F5F5; padding: 5px;" |
+|style="background: #F5F5F5; padding: 5px;" |Clinical assesment
+|style="background: #F5F5F5; padding: 5px;" |
+|style="background: #F5F5F5; padding: 5px;" |
+|style="background: #F5F5F5; padding: 5px;" |✔
+|style="background: #F5F5F5; padding: 5px;" |✔
+|style="background: #F5F5F5; padding: 5px;" |✔
+|style="background: #F5F5F5; padding: 5px;" |✔
+|style="background: #F5F5F5; padding: 5px;" |✔
+|style="background: #F5F5F5; padding: 5px;" |
+|style="background: #F5F5F5; padding: 5px;" |
+|style="background: #F5F5F5; padding: 5px;" |History of hypertension
+|style="background: #F5F5F5; padding: 5px;" |Delirium, cortical blindness, cerebral edema, seizure
+|-
+|style="background: #DCDCDC; padding: 5px; text-align: center;" |Wernicke’s encephalopathy
+|style="background: #F5F5F5; padding: 5px;" |
+|style="background: #F5F5F5; padding: 5px;" |
+|style="background: #F5F5F5; padding: 5px;" |
+|style="background: #F5F5F5; padding: 5px;" |
+|style="background: #F5F5F5; padding: 5px;" |
+|style="background: #F5F5F5; padding: 5px;" |
+|style="background: #F5F5F5; padding: 5px;" |✔
+|style="background: #F5F5F5; padding: 5px;" |✔
+|style="background: #F5F5F5; padding: 5px;" |
+|style="background: #F5F5F5; padding: 5px;" |
+|style="background: #F5F5F5; padding: 5px;" |✔
+|style="background: #F5F5F5; padding: 5px;" |
+|style="background: #F5F5F5; padding: 5px;" |
+|style="background: #F5F5F5; padding: 5px;" |History of alcohal abuse
+|style="background: #F5F5F5; padding: 5px;" |Ophthalmoplegia, confusion
+|-
+|style="background: #DCDCDC; padding: 5px; text-align: center;" |CNS abscess
+|style="background: #F5F5F5; padding: 5px;" |
+|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;" |✔
+|style="background: #F5F5F5; padding: 5px;" |✔
+|style="background: #F5F5F5; padding: 5px;" |✔
+|style="background: #F5F5F5; padding: 5px;" |
+|style="background: #F5F5F5; padding: 5px;" |
+|style="background: #F5F5F5; padding: 5px;" |✔
+|style="background: #F5F5F5; padding: 5px;" |✔
+|style="background: #F5F5F5; padding: 5px;" |
+|style="background: #F5F5F5; padding: 5px;" |
+|style="background: #F5F5F5; padding: 5px;" |History of drug abuse, endocarditis, '''↓''' immune status
+|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;" |
+|style="background: #F5F5F5; padding: 5px;" |
+|style="background: #F5F5F5; padding: 5px;" |
+|style="background: #F5F5F5; padding: 5px;" |
+|style="background: #F5F5F5; padding: 5px;" |
+|style="background: #F5F5F5; padding: 5px;" |
+|style="background: #F5F5F5; padding: 5px;" |✔
+|style="background: #F5F5F5; padding: 5px;" |✔
+|style="background: #F5F5F5; padding: 5px;" |
+|style="background: #F5F5F5; padding: 5px;" |
+|style="background: #F5F5F5; padding: 5px;" |✔
+|style="background: #F5F5F5; padding: 5px;" |
+|style="background: #F5F5F5; padding: 5px;" |
+|style="background: #F5F5F5; padding: 5px;" |
+|style="background: #F5F5F5; padding: 5px;" |Lithium, Sedatives, phenytoin, carbamazepine
+|-
+|style="background: #DCDCDC; padding: 5px; text-align: center;" |Conversion disorder
+| style="background: #F5F5F5; padding: 5px;" |
+|style="background: #F5F5F5; padding: 5px;" |
+|style="background: #F5F5F5; padding: 5px;" |
+|style="background: #F5F5F5; padding: 5px;" |Diagnosis of exclusion
+|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; 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;" |[[Tremor|Tremors]], [[blindness]], difficulty [[swallowing]]
+|-
+|style="background: #DCDCDC; padding: 5px; text-align: center;" |Electrolyte disturbance
+|style="background: #F5F5F5; padding: 5px; text-align:center" |'''↓''' or '''↑'''
+|style="background: #F5F5F5; padding: 5px;" |
+|style="background: #F5F5F5; padding: 5px;" |
+|style="background: #F5F5F5; padding: 5px;" |Depends on the cause
+|style="background: #F5F5F5; padding: 5px;" |
+|style="background: #F5F5F5; padding: 5px;" |
+|style="background: #F5F5F5; padding: 5px;" |
+|style="background: #F5F5F5; padding: 5px;" |
+|style="background: #F5F5F5; padding: 5px;" |
+|style="background: #F5F5F5; padding: 5px;" |
+|style="background: #F5F5F5; padding: 5px;" |
+|style="background: #F5F5F5; padding: 5px;" |
+|style="background: #F5F5F5; padding: 5px;" |
+|style="background: #F5F5F5; padding: 5px;" |
+|style="background: #F5F5F5; padding: 5px;" |Confusion, seizures
+|-
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |Meningitis or encephalitis
+| style="background: #F5F5F5; padding: 5px;" |
+| style="background: #F5F5F5; padding: 5px;" |
+| style="background: #F5F5F5; padding: 5px; text-align:center" |'''↑''' Leukocytes,
+'''↑''' Protein
+↓ Glucose
+| 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>
+| style="background: #F5F5F5; padding: 5px;" |
+| style="background: #F5F5F5; padding: 5px;" |
+| style="background: #F5F5F5; padding: 5px;" |
+| style="background: #F5F5F5; padding: 5px;" |
+| 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;" |
+| style="background: #F5F5F5; padding: 5px;" |
+| style="background: #F5F5F5; padding: 5px;" |[[Fever]], neck
+rigidity
+|-
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |Multiple sclerosis exacerbation
+| style="background: #F5F5F5; padding: 5px;" |
+| 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; 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; text-align:center" |✔
+| style="background: #F5F5F5; padding: 5px;" |
+| style="background: #F5F5F5; padding: 5px;" |
+| style="background: #F5F5F5; padding: 5px; text-align:center" |✔
+| style="background: #F5F5F5; padding: 5px; text-align:center" |✔
+| style="background: #F5F5F5; padding: 5px;" |History of relapses and remissions
+| style="background: #F5F5F5; padding: 5px;" |Blurry vision, [[urinary incontinence]], [[fatigue]]
+|-
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |Seizure
+| style="background: #F5F5F5; padding: 5px; text-align:center" |↓ or '''↑'''
+| style="background: #F5F5F5; padding: 5px;" |
+| style="background: #F5F5F5; padding: 5px;" |
+| 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; text-align:center" |✔
+| style="background: #F5F5F5; padding: 5px;" |
+| style="background: #F5F5F5; padding: 5px;" |
+| style="background: #F5F5F5; padding: 5px;" |
+| style="background: #F5F5F5; padding: 5px;" |
+| 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; text-align:center" |✔
+| style="background: #F5F5F5; padding: 5px;" |Previous history of seizures
+| style="background: #F5F5F5; padding: 5px;" |Confusion, apathy, irritability,
+|-
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |Hypoglycemia
+| style="background: #F5F5F5; padding: 5px; text-align:center" |↓ or '''↑'''
+| style="background: #F5F5F5; padding: 5px;" |
+| style="background: #F5F5F5; padding: 5px;" |
+| style="background: #F5F5F5; padding: 5px;" |Serum blood [[Glucose-1-phosphate adenylyltransferase|glucose]]
+[[HbA1c]]
+| style="background: #F5F5F5; padding: 5px;" |
+| style="background: #F5F5F5; padding: 5px;" |
+| 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; text-align:center" |  ✔
+| style="background: #F5F5F5; padding: 5px; text-align:center" |✔
+| style="background: #F5F5F5; padding: 5px;" |
+| style="background: #F5F5F5; padding: 5px; text-align:center" |✔
+| style="background: #F5F5F5; padding: 5px;" |History of [[Diabetes mellitus|diabetes]]
+| style="background: #F5F5F5; padding: 5px;" |[[Palpitation|Palpitations]], sweating, [[dizziness]], low serum, glucose
+|}
+Stroke should be differentiated from other causes of muscle weakness and paralysis. The differentials include the following:
+{|
+|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
+! rowspan="2" |<small>Diseases</small>
+! colspan="8" |<small>History and Physical
+! colspan="2" |<small>Diagnostic tests</small>
+! rowspan="2" |<small>Other Findings</small>
+|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
+!<small>Motor Deficit</small>
+!<small>Sensory deficit</small>
+!<small>Cranial nerve Involvement</small>
+!<small>Autonomic dysfunction</small>
+!<small>Proximal/Distal/Generalized</small>
+!<small>Ascending/Descending/Systemic</small>
+!<small>Unilateral (UL)
+or Bilateral (BL)
+or
+No Lateralization (NL)</small>
+!<small>Onset</small>
+!<small>Lab or Imaging Findings</small>
+!<small>Specific  test</small>
+|-
+| style="background: #DCDCDC; padding: 5px; text-align: center;" | Adult Botulism
+| 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" |<nowiki>+</nowiki>
+| style="background: #F5F5F5; padding: 5px; text-align:center" |Generalized
+| style="background: #F5F5F5; padding: 5px; text-align:center" |Descending
+| style="background: #F5F5F5; padding: 5px; text-align:center" |BL
+| style="background: #F5F5F5; padding: 5px; text-align:center" |Sudden
+| style="background: #F5F5F5; padding: 5px; text-align:center" |Toxin test
+| style="background: #F5F5F5; padding: 5px; text-align:center" |Blood, Wound, or Stool culture
+| style="background: #F5F5F5; padding: 5px; text-align:center" |[[Diplopia]], [[Hyporeflexia|Hyporeflexia,]] [[Hypotonia]], possible respiratory paralysis
+|-
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |Infant Botulism
+| 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" |<nowiki>+</nowiki>
+| style="background: #F5F5F5; padding: 5px; text-align:center" |Generalized
+| style="background: #F5F5F5; padding: 5px; text-align:center" |Descending
+| style="background: #F5F5F5; padding: 5px; text-align:center" |BL
+| style="background: #F5F5F5; padding: 5px; text-align:center" |Sudden
+| style="background: #F5F5F5; padding: 5px; text-align:center" |Toxin test
+| style="background: #F5F5F5; padding: 5px; text-align:center" |Blood, Wound, or Stool culture
+| style="background: #F5F5F5; padding: 5px; text-align:center" |[[Flaccid paralysis]] ([[Floppy baby syndrome]]), possible respiratory paralysis
+|-
+| style="background: #DCDCDC; padding: 5px; text-align: center;" | [[Guillian-Barre syndrome]]<ref name="pmid22081202">{{cite journal| author=Talukder RK, Sutradhar SR, Rahman KM, Uddin MJ, Akhter H| title=Guillian-Barre syndrome. | journal=Mymensingh Med J | year= 2011 | volume= 20 | issue= 4 | pages= 748-56 | pmid=22081202 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22081202  }}</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" |<nowiki>-</nowiki>
+| style="background: #F5F5F5; padding: 5px; text-align:center" |Generalized
+| style="background: #F5F5F5; padding: 5px; text-align:center" |Ascending
+| style="background: #F5F5F5; padding: 5px; text-align:center" |BL
+| style="background: #F5F5F5; padding: 5px; text-align:center" |Insidious
+| style="background: #F5F5F5; padding: 5px; text-align:center" |CSF: ↑Protein
+↓Cells
+| style="background: #F5F5F5; padding: 5px; text-align:center" |Clinical & Lumbar Puncture
+| style="background: #F5F5F5; padding: 5px; text-align:center" |Progressive [[ascending paralysis]] following infection, possible respiratory paralysis
+|-
+| style="background: #DCDCDC; padding: 5px; text-align: center;" | [[Eaton lambert syndrome|Eaton Lambert syndrome]]<ref name="pmid27412406">{{cite journal| author=Merino-Ramírez MÁ, Bolton CF| title=Review of the Diagnostic Challenges of Lambert-Eaton Syndrome Revealed Through Three Case Reports. | journal=Can J Neurol Sci | year= 2016 | volume= 43 | issue= 5 | pages= 635-47 | pmid=27412406 | doi=10.1017/cjn.2016.268 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27412406  }}</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" |<nowiki>+</nowiki>
+| style="background: #F5F5F5; padding: 5px; text-align:center" |Generalized
+| style="background: #F5F5F5; padding: 5px; text-align:center" |Systemic
+| style="background: #F5F5F5; padding: 5px; text-align:center" |BL
+| style="background: #F5F5F5; padding: 5px; text-align:center" |Intermittent
+| style="background: #F5F5F5; padding: 5px; text-align:center" | [[EMG]], repetitive nerve stimulation test (RNS)
+| style="background: #F5F5F5; padding: 5px; text-align:center" |[[Voltage gated calcium channel|Voltage gated calcium channe]]<nowiki/>l<nowiki/> (VGCC) antibody
+| style="background: #F5F5F5; padding: 5px; text-align:center" |[[Diplopia]], [[ptosis]], improves with movement (as the day progresses)
+|-
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Myasthenia gravis]]<ref name="pmid28029925">{{cite journal| author=Gilhus NE| title=Myasthenia Gravis. | journal=N Engl J Med | year= 2016 | volume= 375 | issue= 26 | pages= 2570-2581 | pmid=28029925 | doi=10.1056/NEJMra1602678 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28029925  }}</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" |<nowiki>+</nowiki>
+| style="background: #F5F5F5; padding: 5px; text-align:center" |Generalized
+| style="background: #F5F5F5; padding: 5px; text-align:center" |Systemic
+| style="background: #F5F5F5; padding: 5px; text-align:center" |BL
+| style="background: #F5F5F5; padding: 5px; text-align:center" |Intermittent
+| style="background: #F5F5F5; padding: 5px; text-align:center" | [[Electromyography|EMG]], [[Edrophonium|Edrophonium test]]
+| style="background: #F5F5F5; padding: 5px; text-align:center" |[[Acetylcholine receptor|Ach receptor]] antibody
+| style="background: #F5F5F5; padding: 5px; text-align:center" |[[Diplopia]], [[ptosis]], worsening with movement (as the day progresses)
+|-
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Electrolyte disturbance]]<ref name="pmid26813501">{{cite journal| author=Ozono K| title=[Diagnostic criteria for vitamin D-deficient rickets and hypocalcemia-]. | journal=Clin Calcium | year= 2016 | volume= 26 | issue= 2 | pages= 215-22 | pmid=26813501 | doi=CliCa1602215222 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26813501  }}</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" |<nowiki>-</nowiki>
+| style="background: #F5F5F5; padding: 5px; text-align:center" |Generalized
+| style="background: #F5F5F5; padding: 5px; text-align:center" |Systemic
+| style="background: #F5F5F5; padding: 5px; text-align:center" |BL
+| style="background: #F5F5F5; padding: 5px; text-align:center" |Insidious
+| style="background: #F5F5F5; padding: 5px; text-align:center" | Electrolyte panel
+| style="background: #F5F5F5; padding: 5px; text-align:center" |↓Ca++, ↓Mg++, ↓K+
+| style="background: #F5F5F5; padding: 5px; text-align:center" |Possible [[arrhythmia]]
+|-
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Organophosphate poisoning|Organophosphate toxicity]]<ref name="pmid15020723">{{cite journal| author=Kamanyire R, Karalliedde L| title=Organophosphate toxicity and occupational exposure. | journal=Occup Med (Lond) | year= 2004 | volume= 54 | issue= 2 | pages= 69-75 | pmid=15020723 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15020723  }}</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" |<nowiki>+</nowiki>
+| style="background: #F5F5F5; padding: 5px; text-align:center" |Generalized
+| style="background: #F5F5F5; padding: 5px; text-align:center" |Ascending
+| style="background: #F5F5F5; padding: 5px; text-align:center" |BL
+| style="background: #F5F5F5; padding: 5px; text-align:center" |Sudden
+| style="background: #F5F5F5; padding: 5px; text-align:center" | Clinical diagnosis: physical exam & history
+| style="background: #F5F5F5; padding: 5px; text-align:center" |Clinical suspicion confirmed with RBC AchE activity
+| style="background: #F5F5F5; padding: 5px; text-align:center" |History of exposure to i[[Insecticide|nsecticide]] or living in farming environment. with : [[Diarrhea]], [[Urination]], [[Miosis]], [[Bradycardia]], [[Lacrimation]], [[Emesis]], [[Salivation]], [[Sweating]]
+|-
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Tick paralysis]] ([[Dermacentor andersoni|Dermacentor tick]])<ref name="pmid23677663">{{cite journal| author=Pecina CA| title=Tick paralysis. | journal=Semin Neurol | year= 2012 | volume= 32 | issue= 5 | pages= 531-2 | pmid=23677663 | doi=10.1055/s-0033-1334474 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23677663  }}</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" |<nowiki>-</nowiki>
+| style="background: #F5F5F5; padding: 5px; text-align:center" |Generalized
+| style="background: #F5F5F5; padding: 5px; text-align:center" |Ascending
+| style="background: #F5F5F5; padding: 5px; text-align:center" |BL
+| style="background: #F5F5F5; padding: 5px; text-align:center" |Insidious
+| style="background: #F5F5F5; padding: 5px; text-align:center" | Clinical diagnosis: physical exam & history
+| style="background: #F5F5F5; padding: 5px; text-align:center" |-
+| style="background: #F5F5F5; padding: 5px; text-align:center" |History of outdoor activity in Northeastern United States. The tick is often still latched to the patient at presentation (often in head and neck area)
+|-
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Tetrodotoxin]] poisoning<ref name="pmid24566728">{{cite journal| author=Bane V, Lehane M, Dikshit M, O'Riordan A, Furey A| title=Tetrodotoxin: chemistry, toxicity, source, distribution and detection. | journal=Toxins (Basel) | year= 2014 | volume= 6 | issue= 2 | pages= 693-755 | pmid=24566728 | doi=10.3390/toxins6020693 | pmc=3942760 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24566728  }}</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" |<nowiki>+</nowiki>
+| style="background: #F5F5F5; padding: 5px; text-align:center" |Generalized
+| style="background: #F5F5F5; padding: 5px; text-align:center" |Systemic
+| style="background: #F5F5F5; padding: 5px; text-align:center" |BL
+| style="background: #F5F5F5; padding: 5px; text-align:center" |Sudden
+| style="background: #F5F5F5; padding: 5px; text-align:center" | Clinical diagnosis: physical exam & dietary history
+| style="background: #F5F5F5; padding: 5px; text-align:center" | -
+| style="background: #F5F5F5; padding: 5px; text-align:center" | History of consumption of puffer fish species.
+|-
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Stroke]]<ref name="pmid8848683">{{cite journal| author=Kuntzer T, Hirt L, Bogousslavsky J| title=[Neuromuscular involvement and cerebrovascular accidents]. | journal=Rev Med Suisse Romande | year= 1996 | volume= 116 | issue= 8 | pages= 605-9 | pmid=8848683 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8848683  }}</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" |<nowiki>+/-</nowiki>
+| style="background: #F5F5F5; padding: 5px; text-align:center" |Generalized
+| style="background: #F5F5F5; padding: 5px; text-align:center" |Systemic
+| style="background: #F5F5F5; padding: 5px; text-align:center" |UL
+| style="background: #F5F5F5; padding: 5px; text-align:center" |Sudden
+| style="background: #F5F5F5; padding: 5px; text-align:center" | MRI +ve for ischemia or hemorrhage
+| style="background: #F5F5F5; padding: 5px; text-align:center" |MRI
+| style="background: #F5F5F5; padding: 5px; text-align:center" |Sudden unilateral motor and sensory deficit in a patient with a history of [[Atherosclerosis|atherosclero]]<nowiki/>tic risk factors (diabetes, hypertension, smoking) or [[Atrial fibrillation|atrial fibrillation.]]
+|-
+| style="background: #DCDCDC; padding: 5px; text-align:center;" | [[Poliomyelitis]]<ref name="pmid19944665">{{cite journal| author=Laffont I, Julia M, Tiffreau V, Yelnik A, Herisson C, Pelissier J| title=Aging and sequelae of poliomyelitis. | journal=Ann Phys Rehabil Med | year= 2010 | volume= 53 | issue= 1 | pages= 24-33 | pmid=19944665 | doi=10.1016/j.rehab.2009.10.002 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19944665  }}</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" |Proximal > Distal
+| style="background: #F5F5F5; padding: 5px; text-align:center" |Systemic
+| style="background: #F5F5F5; padding: 5px; text-align:center" |BL or UL
+| style="background: #F5F5F5; padding: 5px; text-align:center" |Sudden
+| style="background: #F5F5F5; padding: 5px; text-align:center" |
+| style="background: #F5F5F5; padding: 5px; text-align:center" |PCR of CSF
+| style="background: #F5F5F5; padding: 5px; text-align:center" |Asymmetric paralysis following a flu-like syndrome.
+|-
+| style="background: #DCDCDC; padding: 5px; text-align:center;" | [[Transverse myelitis]]<ref name="pmid24099672">{{cite journal| author=West TW| title=Transverse myelitis--a review of the presentation, diagnosis, and initial management. | journal=Discov Med | year= 2013 | volume= 16 | issue= 88 | pages= 167-77 | pmid=24099672 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24099672  }}</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" |<nowiki>+</nowiki>
+| style="background: #F5F5F5; padding: 5px; text-align:center" |Proximal > Distal
+| style="background: #F5F5F5; padding: 5px; text-align:center" |Systemic
+| style="background: #F5F5F5; padding: 5px; text-align:center" |BL or UL
+| style="background: #F5F5F5; padding: 5px; text-align:center" |Sudden
+| style="background: #F5F5F5; padding: 5px; text-align:center" |MRI & [[Lumbar puncture]]
+| style="background: #F5F5F5; padding: 5px; text-align:center" |MRI
+| style="background: #F5F5F5; padding: 5px; text-align:center" |History of chronic viral or autoimmune disease (e.g. [[HIV]])
+|-
+| 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" |Generalized
+| style="background: #F5F5F5; padding: 5px; text-align:center" |Systemic
+| style="background: #F5F5F5; padding: 5px; text-align:center" |BL
+| style="background: #F5F5F5; padding: 5px; text-align:center" |Insidious<nowiki/>
+| style="background: #F5F5F5; padding: 5px; text-align:center" |MRI & [[Lumbar puncture]]
+| style="background: #F5F5F5; padding: 5px; text-align:center" |CSF [[VDRL]]-specifc
+CSF [[FTA-ABS|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; text-align:center" |History of unprotected sex or multiple sexual partners.
+History of [[genital ulcer]] ([[chancre]]), diffuse [[Maculopapular rash|maculopapular ras]]<nowiki/>h.
+|-
+| style="background: #DCDCDC; padding: 5px; text-align:center;" |[[Muscular dystrophy]]<ref name="pmid26457695">{{cite journal| author=Falzarano MS, Scotton C, Passarelli C, Ferlini A| title=Duchenne Muscular Dystrophy: From Diagnosis to Therapy. | journal=Molecules | year= 2015 | volume= 20 | issue= 10 | pages= 18168-84 | pmid=26457695 | doi=10.3390/molecules201018168 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26457695  }}</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" |<nowiki>-</nowiki>
+| style="background: #F5F5F5; padding: 5px; text-align:center" |Proximal > Distal
+| style="background: #F5F5F5; padding: 5px; text-align:center" |Systemic
+| style="background: #F5F5F5; padding: 5px; text-align:center" |BL
+| style="background: #F5F5F5; padding: 5px; text-align:center" |Insidious
+| style="background: #F5F5F5; padding: 5px; text-align:center" | Genetic testing
+| style="background: #F5F5F5; padding: 5px; text-align:center" |[[Muscle biopsy]]
+| style="background: #F5F5F5; padding: 5px; text-align:center" |Progressive proximal lower limb weakness with calf pseudohypertrophy in early childhood. [[Gowers' sign|Gower sign]] positive.
+|-
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Multiple sclerosis]] exacerbation<ref name="pmid27432676">{{cite journal| author=Filippi M, Preziosa P, Rocca MA| title=Multiple sclerosis. | journal=Handb Clin Neurol | year= 2016 | volume= 135 | issue=  | pages= 399-423 | pmid=27432676 | doi=10.1016/B978-0-444-53485-9.00020-9 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27432676  }}</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" |<nowiki>+</nowiki>
+| style="background: #F5F5F5; padding: 5px; text-align:center" |Generalized
+| style="background: #F5F5F5; padding: 5px; text-align:center" |Systemic
+| style="background: #F5F5F5; padding: 5px; text-align:center" |NL
+| style="background: #F5F5F5; padding: 5px; text-align:center" |Sudden
+| style="background: #F5F5F5; padding: 5px; text-align:center" |'''[[CSF|↑]]'''[[CSF]] [[IgG]] levels
+(monoclonal)
+| style="background: #F5F5F5; padding: 5px; text-align:center" |Clinical assessment 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; text-align:center" |[[Blurred vision|Blurry vision]], [[urinary incontinence]], [[fatigue]]
+|-
+| style="background: #DCDCDC; padding: 5px; text-align:center" |[[Amyotrophic lateral sclerosis]]<ref name="pmid27025851">{{cite journal| author=Riva N, Agosta F, Lunetta C, Filippi M, Quattrini A| title=Recent advances in amyotrophic lateral sclerosis. | journal=J Neurol | year= 2016 | volume= 263 | issue= 6 | pages= 1241-54 | pmid=27025851 | doi=10.1007/s00415-016-8091-6 | pmc=4893385 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27025851  }}</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" |<nowiki>-</nowiki>
+| style="background: #F5F5F5; padding: 5px; text-align:center" |Generalized
+| style="background: #F5F5F5; padding: 5px; text-align:center" |Systemic
+| style="background: #F5F5F5; padding: 5px; text-align:center" |BL
+| style="background: #F5F5F5; padding: 5px; text-align:center" |Insidious
+| style="background: #F5F5F5; padding: 5px; text-align:center" | Normal [[Lumbar puncture|LP]] (to rule out DDx)
+| style="background: #F5F5F5; padding: 5px; text-align:center" |MRI & [[Lumbar puncture|LP]]
+| style="background: #F5F5F5; padding: 5px; text-align:center" |Patient initially presents with [[upper motor neuron]] deficit ([[spasticity]]) followed by [[lower motor neuron]] deficit ([[flaccidity]]).
+|-
+| style="background: #DCDCDC; padding: 5px; text-align:center;" | [[Myositis|Inflammatory myopathy]]<ref name="pmid26290112">{{cite journal| author=Michelle EH, Mammen AL| title=Myositis Mimics. | journal=Curr Rheumatol Rep | year= 2015 | volume= 17 | issue= 10 | pages= 63 | pmid=26290112 | doi=10.1007/s11926-015-0541-0 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26290112  }}</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" |<nowiki>-</nowiki>
+| style="background: #F5F5F5; padding: 5px; text-align:center" |Proximal > Distal
+| style="background: #F5F5F5; padding: 5px; text-align:center" |Systemic
+| style="background: #F5F5F5; padding: 5px; text-align:center" |UL or BL
+| style="background: #F5F5F5; padding: 5px; text-align:center" |Insidious
+| style="background: #F5F5F5; padding: 5px; text-align:center" |Elevated [[Creatine kinase|CK]] & [[Aldolase]]
+| style="background: #F5F5F5; padding: 5px; text-align:center" |[[Muscle biopsy]]
+| style="background: #F5F5F5; padding: 5px; text-align:center" |Progressive proximal muscle weakness in 3rd to 5th decade of life. With or without skin manifestations.
+|-
+|}
 ==References==
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