Enterovirus 68 differential diagnosis: Difference between revisions

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Latest revision as of 14:58, 4 November 2018

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

Overview

Enterovirus 68 infection must be differentiated from other diseases that cause fever, cough, malaise, and rhinorrhea such as respiratory syncytial virus, adenovirus, parainfluenza virus, seasonal influenza virus B, coronavirus, and rhinovirus.

Differential Diagnosis

Enterovirus 68 infection must be differentiated from other diseases that produce symptoms such as fever, runny nose, sneezing, cough, malaise, chest pain, and diarrhea. Any viral upper respiratory infection must be included in the differential diagnosis of enterovirus 68 infection, and a definitive diagnosis is commonly achieved by PCR assay of a nasopharingeal or oral swab specimen^[1]^[2]


Differential Diagnosis for Enterovirus 68 Infection^[1]^[2]^[3]

Rhinovirus
Respiratory syncytial virus
Adenovirus
Coronavirus
Parainfluenza virus
Seasonal influenza virus A
Seasonal influenza virus B
Human metapneumovirus
Coxsackievirus
Echovirus
Legionella spp
Haemophilus influenzae
Mycoplasma pneumoniae
Bordetella pertussis

Differentiating Acute Flaccid Myelitis From Other Diseases

The following table differentiates acute flaccid myelitis due to EV-D68 from other diseases that cause muscle weakness, hypotonia, and flaccid paralysis:

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^[4]	+	-	-	-	Generalized	Ascending	BL	Insidious	CSF: ↑Protein ↓Cells	Clinical & Lumbar Puncture	Progressive ascending paralysis following infection, possible respiratory paralysis
Eaton Lambert syndrome^[5]	+	-	+	+	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^[6]	+	-	+	+	Generalized	Systemic	BL	Intermittent	EMG, Edrophonium test	Ach receptor antibody	Diplopia, ptosis, worsening with movement (as the day progresses)
Electrolyte disturbance^[7]	+	+	-	-	Generalized	Systemic	BL	Insidious	Electrolyte panel	↓Ca++, ↓Mg++, ↓K+	Possible arrhythmia
Organophosphate toxicity^[8]	+	+	-	+	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)^[9]	+	-	-	-	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^[10]	+	-	+	+	Generalized	Systemic	BL	Sudden	Clinical diagnosis: physical exam & dietary history	-	History of consumption of puffer fish species.
Stroke^[11]	+/-	+/-	+/-	+/-	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^[12]	+	+	+	+/-	Proximal > Distal	Systemic	BL or UL	Sudden		PCR of CSF	Asymmetric paralysis following a flu-like syndrome.
Transverse myelitis^[13]	+	+	+	+	Proximal > Distal	Systemic	BL or UL	Sudden	MRI & Lumbar puncture	MRI	History of chronic viral or autoimmune disease (e.g. HIV)
Neurosyphilis^[14]^[15]	+	+	-	+/-	Generalized	Systemic	BL	Insidious	MRI & Lumbar puncture	CSF VDRL-specifc CSF FTA-Ab -sensitive^[16]	History of unprotected sex or multiple sexual partners. History of genital ulcer (chancre), diffuse maculopapular rash.
Muscular dystrophy^[17]	+	-	-	-	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^[18]	+	+	+	+	Generalized	Systemic	NL	Sudden	↑CSF IgG levels (monoclonal)	Clinical assessment and MRI ^[19]	Blurry vision, urinary incontinence, fatigue
Amyotrophic lateral sclerosis^[20]	+	-	-	-	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^[21]	+	-	-	-	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 Lu, Q.-B.; Wo, Y.; Wang, H.-Y.; Wei, M.-T.; Zhang, L.; Yang, H.; Liu, E.-M.; Li, T.-Y.; Zhao, Z.-T.; Liu, W.; Cao, W.-C. (2013). "Detection of enterovirus 68 as one of the commonest types of enterovirus found in patients with acute respiratory tract infection in China". Journal of Medical Microbiology. 63 (Pt_3): 408–414. doi:10.1099/jmm.0.068247-0. ISSN 0022-2615.
↑ ^2.0 ^2.1 Lekana-Douki, Sonia; Nkoghe, Dieudonné; Drosten, Christian; Ngoungou, Edgar; Drexler, Jan; Leroy, Eric M (2014). "Viral etiology and seasonality of influenza-like illness in Gabon, March 2010 to June 2011". BMC Infectious Diseases. 14 (1): 373. doi:10.1186/1471-2334-14-373. ISSN 1471-2334.
↑ Jacobson, Lara M.; Redd, John T.; Schneider, Eileen; Lu, Xiaoyan; Chern, Shur-Wern W.; Oberste, M. Steven; Erdman, Dean D.; Fischer, Gayle E.; Armstrong, Gregory L.; Kodani, Maja; Montoya, Jennifer; Magri, Julie M.; Cheek, James E. (2012). "Outbreak of Lower Respiratory Tract Illness Associated With Human Enterovirus 68 Among American Indian Children". The Pediatric Infectious Disease Journal. 31 (3): 309–312. doi:10.1097/INF.0b013e3182443eaf. ISSN 0891-3668.
↑ 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.
↑ 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.
↑ Berger JR, Dean D (2014). "Neurosyphilis". Handb Clin Neurol. 121: 1461–72. doi:10.1016/B978-0-7020-4088-7.00098-5. PMID 24365430.
↑ 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.
↑ 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.
↑ 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.
↑ 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.

[LuWo2013-1] 1.0 ^1.1 Lu, Q.-B.; Wo, Y.; Wang, H.-Y.; Wei, M.-T.; Zhang, L.; Yang, H.; Liu, E.-M.; Li, T.-Y.; Zhao, Z.-T.; Liu, W.; Cao, W.-C. (2013). "Detection of enterovirus 68 as one of the commonest types of enterovirus found in patients with acute respiratory tract infection in China". Journal of Medical Microbiology. 63 (Pt_3): 408–414. doi:10.1099/jmm.0.068247-0. ISSN 0022-2615.

[Lekana-DoukiNkoghe2014-2] 2.0 ^2.1 Lekana-Douki, Sonia; Nkoghe, Dieudonné; Drosten, Christian; Ngoungou, Edgar; Drexler, Jan; Leroy, Eric M (2014). "Viral etiology and seasonality of influenza-like illness in Gabon, March 2010 to June 2011". BMC Infectious Diseases. 14 (1): 373. doi:10.1186/1471-2334-14-373. ISSN 1471-2334.

[JacobsonRedd2012-3] Jacobson, Lara M.; Redd, John T.; Schneider, Eileen; Lu, Xiaoyan; Chern, Shur-Wern W.; Oberste, M. Steven; Erdman, Dean D.; Fischer, Gayle E.; Armstrong, Gregory L.; Kodani, Maja; Montoya, Jennifer; Magri, Julie M.; Cheek, James E. (2012). "Outbreak of Lower Respiratory Tract Illness Associated With Human Enterovirus 68 Among American Indian Children". The Pediatric Infectious Disease Journal. 31 (3): 309–312. doi:10.1097/INF.0b013e3182443eaf. ISSN 0891-3668.

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

[pmid27412406-5] 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.

[pmid28029925-6] Gilhus NE (2016). "Myasthenia Gravis". N Engl J Med. 375 (26): 2570–2581. doi:10.1056/NEJMra1602678. PMID 28029925.

[pmid26813501-7] 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.

[pmid15020723-8] Kamanyire R, Karalliedde L (2004). "Organophosphate toxicity and occupational exposure". Occup Med (Lond). 54 (2): 69–75. PMID 15020723.

[pmid23677663-9] Pecina CA (2012). "Tick paralysis". Semin Neurol. 32 (5): 531–2. doi:10.1055/s-0033-1334474. PMID 23677663.

[pmid24566728-10] 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.

[pmid8848683-11] Kuntzer T, Hirt L, Bogousslavsky J (1996). "[Neuromuscular involvement and cerebrovascular accidents]". Rev Med Suisse Romande. 116 (8): 605–9. PMID 8848683.

[pmid19944665-12] 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.

[pmid24099672-13] West TW (2013). "Transverse myelitis--a review of the presentation, diagnosis, and initial management". Discov Med. 16 (88): 167–77. PMID 24099672.

[pmid22482824-14] 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.

[pmid24365430-15] Berger JR, Dean D (2014). "Neurosyphilis". Handb Clin Neurol. 121: 1461–72. doi:10.1016/B978-0-7020-4088-7.00098-5. PMID 24365430.

[pmid22421697-16] 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.

[pmid26457695-17] 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.

[pmid27432676-18] 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.

[pmid8274111-19] 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.

[pmid27025851-20] 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.

[pmid26290112-21] 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 4: / Line 4: @@
 ==Overview==
-Enterovirus 68 infection must be differentiated from other diseases that cause [[fever]], [[cough]], [[malaise]], and [[coryza]] such as: [[respiratory syncytial virus]], [[adenovirus]], [[parainfluenza virus]], seasonal [[influenza virus]] B, [[coronavirus]], and [[rhinovirus]].
+Enterovirus 68 infection must be differentiated from other diseases that cause [[fever]], [[cough]], [[malaise]], and [[rhinorrhea]] such as [[respiratory syncytial virus]], [[adenovirus]], [[parainfluenza virus]], seasonal [[influenza virus]] B, [[coronavirus]], and [[rhinovirus]].
 ==Differential Diagnosis==
-Enterovirus 68 infection must be differentiated from other diseases that produce symptoms such as [[fever]], [[runny nose]], [[sneezing]], [[cough]], [[malaise]], [[chest pain]], and [[diarrhea]].  Any viral [[upper respiratory infection]] must be included in the differential diagnosis of enterovirus 68 infection, and a definitive diagnosis is achieved by [[PCR]] assay of a nasopharingeal swab specimen or other available secretions.<ref name="LuWo2013">{{cite journal|last1=Lu|first1=Q.-B.|last2=Wo|first2=Y.|last3=Wang|first3=H.-Y.|last4=Wei|first4=M.-T.|last5=Zhang|first5=L.|last6=Yang|first6=H.|last7=Liu|first7=E.-M.|last8=Li|first8=T.-Y.|last9=Zhao|first9=Z.-T.|last10=Liu|first10=W.|last11=Cao|first11=W.-C.|title=Detection of enterovirus 68 as one of the commonest types of enterovirus found in patients with acute respiratory tract infection in China|journal=Journal of Medical Microbiology|volume=63|issue=Pt_3|year=2013|pages=408–414|issn=0022-2615|doi=10.1099/jmm.0.068247-0}}</ref>
+Enterovirus 68 infection must be differentiated from other diseases that produce symptoms such as [[fever]], [[runny nose]], [[sneezing]], [[cough]], [[malaise]], [[chest pain]], and [[diarrhea]].   Any viral [[upper respiratory infection]] must be included in the differential diagnosis of enterovirus 68 infection, and a definitive diagnosis is commonly achieved by [[PCR]] assay of a nasopharingeal or oral swab specimen<ref name="LuWo2013">{{cite journal|last1=Lu|first1=Q.-B.|last2=Wo|first2=Y.|last3=Wang|first3=H.-Y.|last4=Wei|first4=M.-T.|last5=Zhang|first5=L.|last6=Yang|first6=H.|last7=Liu|first7=E.-M.|last8=Li|first8=T.-Y.|last9=Zhao|first9=Z.-T.|last10=Liu|first10=W.|last11=Cao|first11=W.-C.|title=Detection of enterovirus 68 as one of the commonest types of enterovirus found in patients with acute respiratory tract infection in China|journal=Journal of Medical Microbiology|volume=63|issue=Pt_3|year=2013|pages=408–414|issn=0022-2615|doi=10.1099/jmm.0.068247-0}}</ref><ref name="Lekana-DoukiNkoghe2014">{{cite journal|last1=Lekana-Douki|first1=Sonia|last2=Nkoghe|first2=Dieudonné|last3=Drosten|first3=Christian|last4=Ngoungou|first4=Edgar|last5=Drexler|first5=Jan|last6=Leroy|first6=Eric M|title=Viral etiology and seasonality of influenza-like illness in Gabon, March 2010 to June 2011|journal=BMC Infectious Diseases|volume=14|issue=1|year=2014|pages=373|issn=1471-2334|doi=10.1186/1471-2334-14-373}}</ref>
+{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
+|valign=top|
+|+
+! style="background: #4479BA; width: 320px;" | {{fontcolor|#FFF|Differential Diagnosis for Enterovirus 68 Infection<ref name="LuWo2013">{{cite journal|last1=Lu|first1=Q.-B.|last2=Wo|first2=Y.|last3=Wang|first3=H.-Y.|last4=Wei|first4=M.-T.|last5=Zhang|first5=L.|last6=Yang|first6=H.|last7=Liu|first7=E.-M.|last8=Li|first8=T.-Y.|last9=Zhao|first9=Z.-T.|last10=Liu|first10=W.|last11=Cao|first11=W.-C.|title=Detection of enterovirus 68 as one of the commonest types of enterovirus found in patients with acute respiratory tract infection in China|journal=Journal of Medical Microbiology|volume=63|issue=Pt_3|year=2013|pages=408–414|issn=0022-2615|doi=10.1099/jmm.0.068247-0}}</ref><ref name="Lekana-DoukiNkoghe2014">{{cite journal|last1=Lekana-Douki|first1=Sonia|last2=Nkoghe|first2=Dieudonné|last3=Drosten|first3=Christian|last4=Ngoungou|first4=Edgar|last5=Drexler|first5=Jan|last6=Leroy|first6=Eric M|title=Viral etiology and seasonality of influenza-like illness in Gabon, March 2010 to June 2011|journal=BMC Infectious Diseases|volume=14|issue=1|year=2014|pages=373|issn=1471-2334|doi=10.1186/1471-2334-14-373}}</ref><ref name="JacobsonRedd2012">{{cite journal|last1=Jacobson|first1=Lara M.|last2=Redd|first2=John T.|last3=Schneider|first3=Eileen|last4=Lu|first4=Xiaoyan|last5=Chern|first5=Shur-Wern W.|last6=Oberste|first6=M. Steven|last7=Erdman|first7=Dean D.|last8=Fischer|first8=Gayle E.|last9=Armstrong|first9=Gregory L.|last10=Kodani|first10=Maja|last11=Montoya|first11=Jennifer|last12=Magri|first12=Julie M.|last13=Cheek|first13=James E.|title=Outbreak of Lower Respiratory Tract Illness Associated With Human Enterovirus 68 Among American Indian Children|journal=The Pediatric Infectious Disease Journal|volume=31|issue=3|year=2012|pages=309–312|issn=0891-3668|doi=10.1097/INF.0b013e3182443eaf}}</ref>
+}}
+|-
+| style="padding: 5px 5px; background: #DCDCDC;" |
+*[[Rhinovirus]]
+|-
+| style="padding: 5px 5px; background: #F5F5F5;" |
+*[[Respiratory syncytial virus]]
+|-
+| style="padding: 5px 5px; background: #DCDCDC;" |
+*[[Adenovirus]]
+|-
+| style="padding: 5px 5px; background: #F5F5F5;" |
+*[[Coronavirus]]
+|-
+| style="padding: 5px 5px; background: #DCDCDC;" |
+*[[Parainfluenza virus]]
+|-
+| style="padding: 5px 5px; background: #F5F5F5;" |
+*Seasonal [[influenza virus]] A
+|-
+| style="padding: 5px 5px; background: #DCDCDC;"|
+*Seasonal [[influenza virus]] B
+|-
+| style="padding: 5px 5px; background: #F5F5F5;" |
+*Human metapneumovirus
+|-
+| style="padding: 5px 5px; background: #DCDCDC;" |
+*[[Coxsackievirus]]
+|-
+| style="padding: 5px 5px; background: #F5F5F5;" |
+*[[Echovirus]]
+|-
+| style="padding: 5px 5px; background: #DCDCDC;" |
+*[[Legionella|Legionella spp]]
+|-
+| style="padding: 5px 5px; background: #F5F5F5;" |
+*[[Haemophilus influenzae]]
+|-
+| style="padding: 5px 5px; background: #DCDCDC;" |
+*[[Mycoplasma pneumoniae]]
+|-
+| style="padding: 5px 5px; background: #F5F5F5;" |
+*[[Bordetella pertussis]]
+|-
+|}
+==Differentiating Acute Flaccid Myelitis From Other Diseases==
+The following table differentiates acute flaccid myelitis due to EV-D68 from other diseases that cause [[muscle weakness]], [[hypotonia]], and [[flaccid paralysis]]:
+{|
+|- 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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