Neurosyphilis differential diagnosis: Difference between revisions
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==Overview== | ==Overview== | ||
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, [[CNS abscess]], [[electrolyte disturbance]], [[Subdural empyema]], [[Subarachnoid hemorrhage|subarachnoid hemorrhage]], [[Stroke|brain stroke]], [[Conversion disorder]] and [[Drug toxicity]]. | 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== | ==Differentiating X from other Diseases== | ||
* Neuroyphilis has an extensive differential diagnosis. | * Neuroyphilis has an extensive differential diagnosis. | ||
*Neurosyphilis must be differentiated from other diseases that cause abnormal [[gait]], [[Blindness]], [[confusion]] and [[depression]], such as [[Brain tumour]]<nowiki/>s, Wernicke’s encephalopathy, [[CNS abscess]], [[electrolyte disturbance]], [[Subdural empyema]], [[Subarachnoid hemorrhage|subarachnoid hemorrhage]], [[Stroke|brain stroke]], [[Conversion disorder]] and [[Drug toxicity]].<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> | *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> | ||
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* [[tremors]], | * [[tremors]], | ||
* [[mydriasis]] | * [[mydriasis]] | ||
* [[positional nystagmus]], | * [[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> | ||
Latest revision as of 19:03, 9 March 2018
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Neurosyphilis Microchapters |
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Neurosyphilis differential diagnosis On the Web |
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American Roentgen Ray Society Images of Neurosyphilis differential diagnosis |
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Risk calculators and risk factors for Neurosyphilis differential diagnosis |
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 | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 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 | |||
| Neurosyphilis[3][4] | ✔ | ↑ Leukocytes and protein |
|
✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ |
|
| |
| Multiple sclerosis | Oligoclonal bands of IgG on electrophoresis of cerebrospinal fluid | MRI | ✔ | ✔ | ✔ | ✔ | ✔ |
|
| |||||
| Brain tumour[1][2] | ✔ | Cancer cells[7] | MRI | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ |
| ||||
| Wernicke’s encephalopathy | Normal | ✔ | ✔ | ✔ | History of alcohal abuse | |||||||||
| CNS abscess | ✔ |
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|
✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ |
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| Electrolyte disturbance | ↓ or ↑ | Depends on the cause | ✔ | ✔ | ||||||||||
| Subdural empyema | ✔ | Clinical assesment and MRI | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | History of relapses and remissions |
| ||||
| Delirium tremens | ✔ | Clinical diagnosis | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ |
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| Subarachnoid hemorrhage[8] | ✔ | Xanthochromia[9] | CT scan without contrast[11][6] | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | Trauma/fall | ||
| Stroke | ✔ | Normal | CT scan without contrast | ✔ | ✔ | ✔ | ✔ | ✔ | TIAs, hypertension, diabetes mellitus |
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| Viral encephalitis | ✔ |
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Clinical assesment | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ |
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| Herpes simplex encephalitis | ✔ | Clinical assesment | ✔ | ✔ | ✔ | ✔ | ✔ | History of hypertension |
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| Drug toxicity | ✔ | ✔ |
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| Conversion disorder | Diagnosis of exclusion | ✔ | ✔ | ✔ | ✔ | ✔ |
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| Febrile convulsion | Not performed in first simple febrile seizures | Clinical diagnosis and EEG | ✔ | ✔ | ✔ | ✔ |
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Age > 1 month, | ||||||
| Hypoglycemia | ↓ or ↑ | Serum glucose | ✔ | ✔ | ✔ | History of diabetes |
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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.