Neurosyphilis differential diagnosis: Difference between revisions

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Latest revision as of 19:03, 9 March 2018

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohamadmostafa Jahansouz M.D.[2]Tarek Nafee, M.D. [3]

Overview

Neurosyphilis must be differentiated from other diseases that cause abnormal gait, Blindness, confusion and depression, such as multiple sclerosis, Brain tumours, Wernicke’s encephalopathy, CNS abscess, electrolyte disturbance, Subdural empyema, subarachnoid hemorrhage, brain stroke, Conversion disorder and Drug toxicity.

Differentiating X from other Diseases

Neuroyphilis has an extensive differential diagnosis.

Neurosyphilis must be differentiated from other diseases that cause abnormal gait, Blindness, confusion and depression, such as multiple sclerosis, Brain tumours, Wernicke’s encephalopathy, CNS abscess, electrolyte disturbance, Subdural empyema, subarachnoid hemorrhage, brain stroke, Conversion disorder and Drug toxicity.^[1]^[2]^[3]^[4]^[5]^[6]^[7]^[8]^[9]^[10]

Diseases	Diagnostic tests				Physical Examination					Symptoms			Past medical history	Other Findings
Diseases	Na+, K+, Ca2+	CT /MRI	CSF Findings	Gold standard test	Neck stiffness	Motor or Sensory deficit	Papilledema	Bulging fontanelle	Cranial nerves	Headache	Fever	Altered mental status	Past medical history	Other Findings
Neurosyphilis^[3]^[4]		✔	↑ Leukocytes and protein	CSF VDRL-specifc CSF FTA-Ab -sensitive^[5]	✔	✔	✔	✔	✔	✔	✔	✔	Unprotected sexual intercourse, STIs History of multiple sexual partners. History of genital ulcer (chancre)	Blindness confusion, epression, Abnormal gait
Multiple sclerosis			Oligoclonal bands of IgG on electrophoresis of cerebrospinal fluid	MRI	✔	✔			✔	✔		✔	History of fatigue Mood problems Spasticity Bowel and bladder dysfunction	Vision problems Balance problems Dizziness Areas of demyelination in CNS MRI
Brain tumour^[1]^[2]		✔	Cancer cells^[7]	MRI		✔	✔	✔	✔	✔		✔		Cachexia Gradual progression of symptoms
Wernicke’s encephalopathy			Normal				✔	✔			✔		History of alcohal abuse	Ophthalmoplegia confusion
CNS abscess		✔	↑ leukocytes >100,000/ul ↓ glucose and ↑ protien ↑ red blood cells lactic acid >500mg	Contrast enhanced MRI is more sensitive and specific Histopathological examination of brain tissue	✔	✔	✔		✔	✔	✔	✔	History of drug abuse endocarditis	High grade fever Fatigue Nausea vomiting
Electrolyte disturbance	↓ or ↑			Depends on the cause						✔		✔		Confusion Seizures
Subdural empyema		✔		Clinical assesment and MRI	✔	✔	✔	✔	✔			✔	History of relapses and remissions	Blurry vision urinary incontinence Fatigue
Delirium tremens		✔		Clinical diagnosis		✔	✔		✔	✔	✔	✔	Alcohol intake Sudden withdraw or reduction in consumption	Tachycardia diaphoresis hypertension tremors, mydriasis Positional Nystagmus,
Subarachnoid hemorrhage^[8]		✔	Xanthochromia^[9]	CT scan without contrast^[11]^[6]	✔	✔	✔	✔	✔	✔	✔	✔	Trauma/fall	Confusion dizziness Nausea Vomiting
Stroke		✔	Normal	CT scan without contrast		✔	✔		✔	✔		✔	TIAs, hypertension, diabetes mellitus	Speech difficulty Gait abnormality
Viral encephalitis		✔	Increased RBCS or xanthochromia Mononuclear lymphocytosis High protein content Normal glucose	Clinical assesment	✔	✔	✔		✔	✔	✔	✔	Tick bite Mosquito bite Viral prodome for several days	Extreme lethargy Rash hepatosplenomegaly lymphadenopathy behavioural changes
Herpes simplex encephalitis		✔		Clinical assesment			✔	✔	✔	✔	✔		History of hypertension	Delirium Cortical blindness cerebral edema seizure
Drug toxicity											✔	✔		Lithium Sedatives phenytoin carbamazepine
Conversion disorder				Diagnosis of exclusion		✔		✔		✔	✔	✔		Tremors blindness Difficulty swallowing
Febrile convulsion			Not performed in first simple febrile seizures	Clinical diagnosis and EEG					✔	✔	✔	✔	Family history of febrile seizures Family history of gastroenteritis Family history of viral illness or	Age > 1 month,
Hypoglycemia	↓ or ↑			Serum glucose HbA1c		✔				✔		✔	History of diabetes	Palpitations sweating dizziness Low serum glucose

References

↑ ^1.0 ^1.1 Soffer D (1976) Brain tumors simulating purulent meningitis. Eur Neurol 14 (3):192-7. PMID: 1278192
↑ ^2.0 ^2.1
↑ ^3.0 ^3.1 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.
↑ ^4.0 ^4.1 Berger JR, Dean D (2014). "Neurosyphilis". Handb Clin Neurol. 121: 1461–72. doi:10.1016/B978-0-7020-4088-7.00098-5. PMID 24365430.
↑ ^5.0 ^5.1 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.
↑ ^6.0 ^6.1 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.
↑ ^7.0 ^7.1 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.
↑ ^8.0 ^8.1 Yeh ST, Lee WJ, Lin HJ, Chen CY, Te AL, Lin HJ (2003) Nonaneurysmal subarachnoid hemorrhage secondary to tuberculous meningitis: report of two cases. J Emerg Med 25 (3):265-70. PMID: 14585453
↑ ^9.0 ^9.1 Lee MC, Heaney LM, Jacobson RL, Klassen AC (1975). "Cerebrospinal fluid in cerebral hemorrhage and infarction". Stroke. 6 (6): 638–41. PMID 1198628.
↑ Goldenberg MM (2012). "Multiple sclerosis review". P T. 37 (3): 175–84. PMC 3351877. PMID 22605909.
↑ Birenbaum D, Bancroft LW, Felsberg GJ (2011). "Imaging in acute stroke". West J Emerg Med. 12 (1): 67–76. PMC 3088377. PMID 21694755.

Template:WH Template:WS

[pmid1278192-1] 1.0 ^1.1 Soffer D (1976) Brain tumors simulating purulent meningitis. Eur Neurol 14 (3):192-7. PMID: 1278192

[pmid3883130-2] 2.0 ^2.1

[pmid22482824-3] 3.0 ^3.1 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.

[pmid24365430-4] 4.0 ^4.1 Berger JR, Dean D (2014). "Neurosyphilis". Handb Clin Neurol. 121: 1461–72. doi:10.1016/B978-0-7020-4088-7.00098-5. PMID 24365430.

[pmid22421697-5] 5.0 ^5.1 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.

[pmid21807345-6] 6.0 ^6.1 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.

[pmid21371327-7] 7.0 ^7.1 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.

[pmid14585453-8] 8.0 ^8.1 Yeh ST, Lee WJ, Lin HJ, Chen CY, Te AL, Lin HJ (2003) Nonaneurysmal subarachnoid hemorrhage secondary to tuberculous meningitis: report of two cases. J Emerg Med 25 (3):265-70. PMID: 14585453

[pmid1198628-9] 9.0 ^9.1 Lee MC, Heaney LM, Jacobson RL, Klassen AC (1975). "Cerebrospinal fluid in cerebral hemorrhage and infarction". Stroke. 6 (6): 638–41. PMID 1198628.

[pmid22605909-10] Goldenberg MM (2012). "Multiple sclerosis review". P T. 37 (3): 175–84. PMC 3351877. PMID 22605909.

[pmid21694755-11] Birenbaum D, Bancroft LW, Felsberg GJ (2011). "Imaging in acute stroke". West J Emerg Med. 12 (1): 67–76. PMC 3088377. PMID 21694755.

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@@ Line 1: / Line 1: @@
 __NOTOC__
 {{Neurosyphilis}}
-{{CMG}}; {{AE}}{{TarekNafee}}
+{{CMG}}; {{AE}}{{MMJ}}{{TarekNafee}}
 ==Overview==
-==Differential Diagnosis==
+Neurosyphilis must be differentiated from other diseases that cause abnormal [[gait]], [[Blindness]], [[confusion]] and [[depression]], such as [[multiple sclerosis]], [[Brain tumour]]<nowiki/>s, [[Wernicke's encephalopathy|Wernicke’s encephalopathy]], [[CNS abscess]], [[electrolyte disturbance]], [[Subdural empyema]], [[Subarachnoid hemorrhage|subarachnoid  hemorrhage]], [[Stroke|brain stroke]], [[Conversion disorder]] and [[Drug toxicity]].
+==Differentiating X from other Diseases==
+* Neuroyphilis has an extensive differential diagnosis.
+*Neurosyphilis must be differentiated from other diseases that cause abnormal [[gait]], [[Blindness]], [[confusion]] and [[depression]], such as [[multiple sclerosis]], [[Brain tumour]]<nowiki/>s, [[Wernicke's encephalopathy|Wernicke’s encephalopathy]], [[CNS abscess]], [[electrolyte disturbance]], [[Subdural empyema]], [[Subarachnoid hemorrhage|subarachnoid  hemorrhage]], [[Stroke|brain stroke]], [[Conversion disorder]] and [[Drug toxicity]].<nowiki/><nowiki/><ref name="pmid1278192" /><ref name="pmid3883130" /><ref name="pmid22482824" /><ref name="pmid24365430" /><ref name="pmid22421697" /><ref name="pmid21807345" /><ref name="pmid21371327" /><ref name="pmid14585453" /><ref name="pmid1198628" /><ref name="pmid22605909">{{cite journal| author=Goldenberg MM| title=Multiple sclerosis review. | journal=P T | year= 2012 | volume= 37 | issue= 3 | pages= 175-84 | pmid=22605909 | doi= | pmc=3351877 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22605909  }} </ref>
 {|
-|-style="background: #4479BA; color: #FFFFFF; text-align: center;"
+|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
 ! rowspan="2" |<small>Diseases</small>
 ! colspan="4" |<small>Diagnostic tests</small>
@@ Line 28: / Line 32: @@
 !<small>Altered mental status</small>
 |-
-|style="background: #DCDCDC; padding: 5px; text-align: center;" | [[Brain tumour]]<ref name="pmid1278192">Soffer D (1976) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=1278192 Brain tumors simulating purulent meningitis.] ''Eur Neurol'' 14 (3):192-7. PMID: [http://pubmed.gov/1278192 1278192]</ref><ref name="pmid3883130" />
+| 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;" |
-|style="background: #F5F5F5; padding: 5px; text-align:center"|✔
+| 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;" |'''↑''' [[Leukocytes]] and [[protein]]
-|style="background: #F5F5F5; padding: 5px;" |MRI
+| 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;" |
+* Unprotected sexual intercourse, [[STI]]<nowiki/>s
+* History of multiple sexual partners.
+* History of [[genital ulcer]] ([[chancre]])
+| style="background: #F5F5F5; padding: 5px;" |
+* [[Blindness]]
+* [[confusion]],
+* [[depression|epression]],
+* Abnormal [[gait]]
+|-
+|[[Multiple sclerosis]]
+|
+|
+|[[Oligoclonal band|Oligoclonal bands of IgG]] on [[electrophoresis]] of [[cerebrospinal fluid]]
+|MRI
+|✔
+|✔
+|
+|
+|✔
+|✔
+|
+|✔
+|
+* History of [[fatigue]]
+* Mood problems
+* [[Spasticity]]
+* [[Bowel]] and [[bladder]] dysfunction
+|
+*[[Vision problems]]
+*[[Balance disorder|Balance problems]]
+*[[Dizziness]]
+*Areas of [[demyelination]] in [[CNS]] [[MRI]]
+|-
+| style="background: #DCDCDC; padding: 5px; text-align: center;" | [[Brain tumour]]<ref name="pmid1278192">Soffer D (1976) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=1278192 Brain tumors simulating purulent meningitis.] ''Eur Neurol'' 14 (3):192-7. PMID: [http://pubmed.gov/1278192 1278192]</ref><ref name="pmid3883130" />
+| 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;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;" |
+| style="background: #F5F5F5; padding: 5px;" |
-|style="background: #F5F5F5; padding: 5px;" |[[Cachexia]], gradual progression of symptoms
+| style="background: #F5F5F5; padding: 5px;" |
+* [[Cachexia]]
+* Gradual progression of symptoms
+|-
+| 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;" |Normal
+| 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;" |[[Delirium tremens]]
+| 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; text-align:center" |✔
+| style="background: #F5F5F5; padding: 5px;" |✔
+| style="background: #F5F5F5; padding: 5px;" |
+* '''↑''' [[leukocytes]] >100,000/ul
+* '''↓''' [[glucose]] and '''↑''' protien
+* '''↑''' red blood cells
+* [[lactic acid]] >500mg
+| style="background: #F5F5F5; padding: 5px;" |
+* Contrast enhanced MRI is more sensitive and specific
+* [[Histopathological]] examination of brain tissue
+| 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]]
+| style="background: #F5F5F5; padding: 5px;" |
+* High grade [[fever]]
+* F[[fatigue|atigue]]
+* N[[Nausea and vomiting|ausea]]
+* [[vomiting]]
+|-
+| 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;" |
+* [[Confusion]]
+* S[[Seizure|eizures]]
+|-
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Subdural empyema]]
+| 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;" |Clinical assesment and [[MRI]]
+| 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;" |History of relapses and remissions
+| style="background: #F5F5F5; padding: 5px;" |
+* Blurry vision
+* [[urinary incontinence]]
+* F[[fatigue|atigue]]
+|-
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Delirium tremens]]
+| style="background: #F5F5F5; padding: 5px;" |
+| style="background: #F5F5F5; padding: 5px; text-align:center" |✔
 | style="background: #F5F5F5; padding: 5px;" |
 | style="background: #F5F5F5; padding: 5px;" |Clinical diagnosis
 | style="background: #F5F5F5; padding: 5px; text-align:center" |
-|style="background: #F5F5F5; padding: 5px; text-align:center" |✔
+| style="background: #F5F5F5; padding: 5px; text-align:center" |✔
-|style="background: #F5F5F5; padding: 5px;text-align:center" |✔
+| style="background: #F5F5F5; padding: 5px;text-align:center" |✔
 | style="background: #F5F5F5; padding: 5px;text-align:center" |
 | style="background: #F5F5F5; padding: 5px; text-align:center" |      ✔
 | style="background: #F5F5F5; padding: 5px; text-align:center" | ✔
-|style="background: #F5F5F5; padding: 5px; text-align:center" |✔
+| style="background: #F5F5F5; padding: 5px; text-align:center" |✔
-|style="background: #F5F5F5; padding: 5px; text-align:center" |✔
+| style="background: #F5F5F5; padding: 5px; text-align:center" |✔
-|style="background: #F5F5F5; padding: 5px;" |[[Alcohol]] intake, sudden witdrawl or reduction in consumption
+| style="background: #F5F5F5; padding: 5px;" |
-|style="background: #F5F5F5; padding: 5px;" |[[Tachycardia]], [[diaphoresis]], [[hypertension]], [[tremors]], [[mydriasis]], [[positional nystagmus]],
+* [[Alcohol]] intake
+* Sudden withdraw or reduction in consumption
+| style="background: #F5F5F5; padding: 5px;" |
+* [[Tachycardia]]
+* [[diaphoresis]]
+* [[hypertension]]
+* [[tremors]],
+* [[mydriasis]]
+* [[positional nystagmus|Positional Nystagmus]],
 |-
-|style="background: #DCDCDC; padding: 5px; text-align: center;" | [[Subarachnoid hemorrhage|Subarachnoid  hemorrhage]]<ref name="pmid14585453">Yeh ST, Lee WJ, Lin HJ, Chen CY, Te AL, Lin HJ (2003) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=14585453 Nonaneurysmal subarachnoid hemorrhage secondary to tuberculous meningitis: report of two cases.] ''J Emerg Med'' 25 (3):265-70. PMID: [http://pubmed.gov/14585453 14585453]</ref>
+| style="background: #DCDCDC; padding: 5px; text-align: center;" | [[Subarachnoid hemorrhage|Subarachnoid  hemorrhage]]<ref name="pmid14585453">Yeh ST, Lee WJ, Lin HJ, Chen CY, Te AL, Lin HJ (2003) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=14585453 Nonaneurysmal subarachnoid hemorrhage secondary to tuberculous meningitis: report of two cases.] ''J Emerg Med'' 25 (3):265-70. PMID: [http://pubmed.gov/14585453 14585453]</ref>
-|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;" |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;" |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;" |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; 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;" |Trauma/fall
+| style="background: #F5F5F5; padding: 5px;" |Trauma/fall
-|style="background: #F5F5F5; padding: 5px;" |[[Confusion]], [[dizziness]], [[Nausea and vomiting|nausea]], [[Nausea and vomiting|vomiting]]
+| style="background: #F5F5F5; padding: 5px;" |
+* [[Confusion]]
+* [[dizziness]]
+* [[Nausea and vomiting|Nausea]]
+* [[Nausea and vomiting|Vomiting]]
 |-
-|style="background: #DCDCDC; padding: 5px; text-align: center;" | [[Stroke]]
+| style="background: #DCDCDC; padding: 5px; text-align: center;" | [[Stroke]]
-|style="background: #F5F5F5; padding: 5px; text-align:center"|
+| style="background: #F5F5F5; padding: 5px; text-align:center" |
-|style="background: #F5F5F5; padding: 5px; text-align:center"|✔
+| style="background: #F5F5F5; padding: 5px; text-align:center" |✔
-|style="background: #F5F5F5; padding: 5px; text-align:center"| Normal
+| style="background: #F5F5F5; padding: 5px; text-align:center" | Normal
-|style="background: #F5F5F5; padding: 5px; text-align:center"| CT scan  without contrast
+| style="background: #F5F5F5; padding: 5px; text-align:center" | CT scan  without contrast
-|style="background: #F5F5F5; padding: 5px; text-align:center"|
+| style="background: #F5F5F5; padding: 5px; text-align:center" |
-|style="background: #F5F5F5; padding: 5px; text-align:center"|✔
+| style="background: #F5F5F5; padding: 5px; text-align:center" |✔
-|style="background: #F5F5F5; padding: 5px; text-align:center"|✔
+| style="background: #F5F5F5; padding: 5px; text-align:center" |✔
-|style="background: #F5F5F5; padding: 5px; text-align:center"|
+| style="background: #F5F5F5; padding: 5px; text-align:center" |
-|style="background: #F5F5F5; padding: 5px; text-align:center"|✔
+| style="background: #F5F5F5; padding: 5px; text-align:center" |✔
-|style="background: #F5F5F5; padding: 5px; 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"|TIAs, [[hypertension]], [[diabetes mellitus]]
+| style="background: #F5F5F5; padding: 5px; text-align:center" |TIAs, [[hypertension]], [[diabetes mellitus]]
-|style="background: #F5F5F5; padding: 5px; text-align:center"|Speech difficulty, gait abnormality
+| style="background: #F5F5F5; padding: 5px; text-align:center" |
+* Speech difficulty
+* Gait abnormality
 |-
-|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: #DCDCDC; padding: 5px; text-align: center;" |[[Viral encephalitis]]
-|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;" |'''↑''' [[Leukocytes]] and [[protein]]
+| style="background: #F5F5F5; padding: 5px;" |
-|style="background: #F5F5F5; padding: 5px;" |CSF [[VDRL]]-specifc
+* Increased [[RBC]]S or xanthochromia
-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>
+* [[Mononuclear cells|Mononuclear]] [[lymphocytosis]]
-|style="background: #F5F5F5; padding: 5px; text-align:center" |✔
+* High protein content
-|style="background: #F5F5F5; padding: 5px; text-align:center" |✔
+* Normal [[glucose]]
-|style="background: #F5F5F5; padding: 5px;text-align:center" |✔
+| style="background: #F5F5F5; padding: 5px;" |Clinical assesment
-|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; 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;" |Unprotected sexual intercourse, [[STI]]<nowiki/>s
-|style="background: #F5F5F5; padding: 5px;" |[[Blindness]], [[confusion]], [[depression]],
-Abnormal [[gait]]
-|-
-|style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Viral encephalitis]]
-|style="background: #F5F5F5; padding: 5px;" |
-|style="background: #F5F5F5; padding: 5px;" |✔
-|style="background: #F5F5F5; padding: 5px;" |Increased [[RBC]]S or xanthochromia, [[Mononuclear cells|mononuclear]] [[lymphocytosis]], high protein content, normal [[glucose]]
-|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; 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;" |Tick bite/mosquito bite/ viral prodome for several days
+| style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |Extreme lethargy, rash [[hepatosplenomegaly]], [[lymphadenopathy]], [[behavioural]] changes
+* Tick bite
+* Mosquito bite
+* Viral prodome for several days
+| style="background: #F5F5F5; padding: 5px;" |
+* Extreme lethargy
+* Rash
+* [[hepatosplenomegaly]]
+* [[lymphadenopathy]]
+* [[behavioural]] changes
 |-
-|style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Herpes simplex encephalitis]]
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Herpes simplex encephalitis]]
-|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;" |Clinical assesment
+| 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;" |✔
-|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;" |History of [[hypertension]]
-|style="background: #F5F5F5; padding: 5px;" |[[Delirium]], cortical [[blindness]], [[cerebral edema]], [[seizure]]
+| style="background: #F5F5F5; padding: 5px;" |
+* [[Delirium]]
+* Cortical [[blindness]]
+* [[cerebral edema]]
+* [[seizure]]
 |-
-|style="background: #DCDCDC; padding: 5px; text-align: center;" |Wernicke’s encephalopathy
+| 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;" |Normal
+| 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;" |
-|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;" |
-|style="background: #F5F5F5; padding: 5px;" |[[Ophthalmoplegia]], [[confusion]]
+| style="background: #F5F5F5; padding: 5px;" |
+* [[Lithium]]
+* Sedatives
+* [[phenytoin]]
+* [[carbamazepine]]
 |-
-|style="background: #DCDCDC; padding: 5px; text-align: center;" |[[CNS abscess]]
+| 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;" |'''↑''' [[leukocytes]] >100,000/ul, '''↓''' [[glucose]] and '''↑''' protien, '''↑''' red blood cells, [[lactic acid]] >500mg
-|style="background: #F5F5F5; padding: 5px;" |Contrast enhanced MRI is more sensitive and specific,
-[[Histopathological]] examination of brain tissue
-|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 and vomiting|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;" |[[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;" |Diagnosis of exclusion
-|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;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; 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;" |[[Tremor|Tremors]], [[blindness]], difficulty [[swallowing]]
+| style="background: #F5F5F5; padding: 5px;" |
-|-
+* [[Tremor|Tremors]]
-|style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Electrolyte disturbance]]
+* [[blindness]]
-|style="background: #F5F5F5; padding: 5px; text-align:center" |'''↓''' or '''↑'''
+* Difficulty [[swallowing]]
-|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;" |[[Confusion]], [[Seizure|seizures]]
 |-
 | style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Febrile convulsion]]
@@ Line 238: / Line 352: @@
 | style="background: #F5F5F5; padding: 5px;" |✔
 | style="background: #F5F5F5; padding: 5px;" |✔
-| style="background: #F5F5F5; padding: 5px;" |Family history of [[febrile]] [[seizures]], [[viral]] illness or [[gastroenteritis]]
+| style="background: #F5F5F5; padding: 5px;" |
+* Family history of [[febrile]] [[seizures]]
+* Family history of [[gastroenteritis]]
+* Family history of [[viral]] illness or
 | style="background: #F5F5F5; padding: 5px;" |Age > 1 month,
-|-
-| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Subdural empyema]]
-| 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;" |Clinical assesment and [[MRI]]
-| 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;" |History of relapses and remissions
-| style="background: #F5F5F5; padding: 5px;" |Blurry vision, [[urinary incontinence]], [[fatigue]]
 |-
 | style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Hypoglycemia]]
@@ Line 261: / Line 363: @@
 | style="background: #F5F5F5; padding: 5px;" |
 | style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |Serum blood [[Glucose-1-phosphate adenylyltransferase|glucose]]
+| style="background: #F5F5F5; padding: 5px;" |Serum [[Glucose-1-phosphate adenylyltransferase|glucose]]
 [[HbA1c]]
 | style="background: #F5F5F5; padding: 5px;" |
@@ Line 272: / Line 374: @@
 | style="background: #F5F5F5; padding: 5px;" |✔
 | style="background: #F5F5F5; padding: 5px;" |History of [[Diabetes mellitus|diabetes]]
-| style="background: #F5F5F5; padding: 5px;" |[[Palpitation|Palpitations]], [[sweating]], [[dizziness]], low serum, [[glucose]]
+| style="background: #F5F5F5; padding: 5px;" |
+* [[Palpitation|Palpitations]]
+* [[sweating]]
+* [[dizziness]]
+* Low serum [[glucose]]
 |}
-{|
-|- 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==

Neurosyphilis differential diagnosis: Difference between revisions

Latest revision as of 19:03, 9 March 2018

Overview

Differentiating X from other Diseases

References

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