Headache differential diagnosis: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Headache]] | |||
'''For the WikiDoc page for this topic, click [[Headache|here]]''' | |||
{{CMG}} {{AE}} {{SAI}} | {{CMG}} {{AE}} {{SAI}} | ||
Differential diagnosis of headache includes: Migraine, tension-type headache, cluster headache, seizure, meningitis, encephalitis, neurosyphilis, SAH, subdural hematoma, brain tumor, hypertensive encephalopathy, brain abscess, multiple sclerosis, hemorrhagic stroke, Wernickes encephalopathy, and drug toxicity etc.<ref name="pmid14503985">{{cite journal |vauthors= |title=National guidelines for analysis of cerebrospinal fluid for bilirubin in suspected subarachnoid haemorrhage |journal=Ann. Clin. Biochem. |volume=40 |issue=Pt 5 |pages=481–8 |date=September 2003 |pmid=14503985 |doi=10.1258/000456303322326399 |url=}}</ref><ref name="pmid23717798">{{cite journal| author=Le Rhun E, Taillibert S, Chamberlain MC| title=Carcinomatous meningitis: Leptomeningeal metastases in solid tumors. | journal=Surg Neurol Int | year= 2013 | volume= 4 | issue= Suppl 4 | pages= S265-88 | pmid=23717798 | doi=10.4103/2152-7806.111304 | pmc=3656567 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23717798 }} </ref><ref name="pmid24326618">{{cite journal| author=Chow E, Troy SB| title=The differential diagnosis of hypoglycorrhachia in adult patients. | journal=Am J Med Sci | year= 2014 | volume= 348 | issue= 3 | pages= 186-90 | pmid=24326618 | doi=10.1097/MAJ.0000000000000217 | pmc=4065645 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24326618 }} </ref><ref name="pmid22880096">{{cite journal| author=Leen WG, Willemsen MA, Wevers RA, Verbeek MM| title=Cerebrospinal fluid glucose and lactate: age-specific reference values and implications for clinical practice. | journal=PLoS One | year= 2012 | volume= 7 | issue= 8 | pages= e42745 | pmid=22880096 | doi=10.1371/journal.pone.0042745 | pmc=3412827 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22880096 }} </ref><ref name="pmid10654948">{{cite journal| author=Negrini B, Kelleher KJ, Wald ER| title=Cerebrospinal fluid findings in aseptic versus bacterial meningitis. | journal=Pediatrics | year= 2000 | volume= 105 | issue= 2 | pages= 316-9 | pmid=10654948 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10654948 }} </ref><ref name="pmid20610819">{{cite journal| author=Brouwer MC, Tunkel AR, van de Beek D| title=Epidemiology, diagnosis, and antimicrobial treatment of acute bacterial meningitis. | journal=Clin Microbiol Rev | year= 2010 | volume= 23 | issue= 3 | pages= 467-92 | pmid=20610819 | doi=10.1128/CMR.00070-09 | pmc=2901656 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20610819 }} </ref><ref name="pmid2769274">{{cite journal |vauthors=Vermeulen M, Hasan D, Blijenberg BG, Hijdra A, van Gijn J |title=Xanthochromia after subarachnoid haemorrhage needs no revisitation |journal=J. Neurol. Neurosurg. Psychiatry |volume=52 |issue=7 |pages=826–8 |date=July 1989 |pmid=2769274 |pmc=1031927 |doi=10.1136/jnnp.52.7.826 |url=}}</ref><ref name="pmid15885053">{{cite journal |vauthors=Wasay M, Mekan SF, Khelaeni B, Saeed Z, Hassan A, Cheema Z, Bakshi R |title=Extra temporal involvement in herpes simplex encephalitis |journal=Eur. J. Neurol. |volume=12 |issue=6 |pages=475–9 |date=June 2005 |pmid=15885053 |doi=10.1111/j.1468-1331.2005.00999.x |url=}}</ref><ref name="pmid17109290">{{cite journal |vauthors=Glaser CA, Honarmand S, Anderson LJ, Schnurr DP, Forghani B, Cossen CK, Schuster FL, Christie LJ, Tureen JH |title=Beyond viruses: clinical profiles and etiologies associated with encephalitis |journal=Clin. Infect. Dis. |volume=43 |issue=12 |pages=1565–77 |date=December 2006 |pmid=17109290 |doi=10.1086/509330 |url=}}</ref><ref name="pmid21490181">{{cite journal |vauthors=Meltzer EO, Hamilos DL |title=Rhinosinusitis diagnosis and management for the clinician: a synopsis of recent consensus guidelines |journal=Mayo Clin. Proc. |volume=86 |issue=5 |pages=427–43 |date=May 2011 |pmid=21490181 |pmc=3084646 |doi=10.4065/mcp.2010.0392 |url=}}</ref><ref name="pmid1941010">{{cite journal |vauthors=Rasmussen BK, Jensen R, Schroll M, Olesen J |title=Epidemiology of headache in a general population--a prevalence study |journal=J Clin Epidemiol |volume=44 |issue=11 |pages=1147–57 |date=1991 |pmid=1941010 |doi=10.1016/0895-4356(91)90147-2 |url=}}</ref><ref name="pmid15447695">{{cite journal |vauthors=Kelman L |title=The premonitory symptoms (prodrome): a tertiary care study of 893 migraineurs |journal=Headache |volume=44 |issue=9 |pages=865–72 |date=October 2004 |pmid=15447695 |doi=10.1111/j.1526-4610.2004.04168.x |url=}}</ref><ref name="pmid26643378">{{cite journal |vauthors=Laurell K, Artto V, Bendtsen L, Hagen K, Häggström J, Linde M, Söderström L, Tronvik E, Wessman M, Zwart JA, Kallela M |title=Premonitory symptoms in migraine: A cross-sectional study in 2714 persons |journal=Cephalalgia |volume=36 |issue=10 |pages=951–9 |date=September 2016 |pmid=26643378 |doi=10.1177/0333102415620251 |url=}}</ref><ref>{{cite web | author=Charlotte E. Grayson and The Cleveland Clinic Neuroscience Center | title=Cluster Headaches |url=http://www.webmd.com/content/article/46/1826_50688.htm | date=October 2004 | publisher=WebMD | accessdate=2006-09-22}}</ref><ref name="pmid7888747">{{cite journal |vauthors=Drummond PD |title=Sweating and vascular responses in the face: normal regulation and dysfunction in migraine, cluster headache and harlequin syndrome |journal=Clin. Auton. Res. |volume=4 |issue=5 |pages=273–85 |date=October 1994 |pmid=7888747 |doi=10.1007/BF01827433 |url=}}</ref><ref name="pmid16686902">{{cite journal |vauthors=Drummond PD |title=Mechanisms of autonomic disturbance in the face during and between attacks of cluster headache |journal=Cephalalgia |volume=26 |issue=6 |pages=633–41 |date=June 2006 |pmid=16686902 |doi=10.1111/j.1468-2982.2006.01106.x |url=}}</ref><ref name="pmid2245469">{{cite journal |vauthors=Ekbom K |title=Evaluation of clinical criteria for cluster headache with special reference to the classification of the International Headache Society |journal=Cephalalgia |volume=10 |issue=4 |pages=195–7 |date=August 1990 |pmid=2245469 |doi=10.1046/j.1468-2982.1990.1004195.x |url=}}</ref><ref name="pmid7697707">{{cite journal |vauthors=Sandrini G, Antonaci F, Pucci E, Bono G, Nappi G |title=Comparative study with EMG, pressure algometry and manual palpation in tension-type headache and migraine |journal=Cephalalgia |volume=14 |issue=6 |pages=451–7; discussion 394–5 |date=December 1994 |pmid=7697707 |doi=10.1046/j.1468-2982.1994.1406451.x |url=}}</ref><ref name="pmid7515793">{{cite journal |vauthors=Jensen R, Fuglsang-Frederiksen A |title=Quantitative surface EMG of pericranial muscles. Relation to age and sex in a general population |journal=Electroencephalogr Clin Neurophysiol |volume=93 |issue=3 |pages=175–83 |date=June 1994 |pmid=7515793 |doi=10.1016/0168-5597(94)90038-8 |url=}}</ref> | |||
</small></small> | |||
{| class="wikitable" | {| class="wikitable" | ||
|+ | |+ | ||
!Disease | ! rowspan="2" |Disease | ||
! colspan=" | ! colspan="13" |History and Physical Examination | ||
! rowspan="2" |PMHx | ! rowspan="2" |PMHx | ||
! colspan="3" |Diagnostic approach | ! colspan="3" |Diagnostic approach | ||
|- | |- | ||
!Bilateral | !Bilateral | ||
!Throbbing character | |||
!Autonomic symptoms | |||
!Fever | !Fever | ||
! | !Photophobia | ||
!Aphasia | |||
!LOC | !LOC | ||
!Aura | !Aura | ||
!Nause/ | !Nause/ | ||
Vomiting | |||
!Rash | !Rash | ||
!Neck stiffness | |||
!Vision changes | |||
!Neurologic deficits | |||
!Labs and CSF findings | !Labs and CSF findings | ||
!CT/MRI | !CT/MRI | ||
!Gold standard test | !Gold standard test | ||
|- | |- | ||
|Migraine | |[[Migraine]] | ||
| | |<nowiki>-</nowiki> | ||
| | | + | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>+</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>+</nowiki> | ||
| | |<nowiki>+</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | | + | ||
| | |<nowiki>-</nowiki> | ||
|Trigger factors, family hx | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|Clinical assesment | |||
|- | |- | ||
|Tension-type headache (TTH) | |[[Tension-type headache|Tension-type headache (TTH)]] | ||
| | |<nowiki>+</nowiki> | ||
| | | - | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | | - | ||
| | |<nowiki>-</nowiki> | ||
|[[stress]], [[genetics]] | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|Clinical assesment | |||
|- | |- | ||
|Cluster headache | |[[Cluster headache]] | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>+</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>+</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
|episodic history | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|Clinical assesment | |||
|- | |- | ||
|[[Seizure]] | |[[Seizure]] | ||
| | |<nowiki>+</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>+/-</nowiki> | ||
| | |<nowiki>+</nowiki> | ||
| | |<nowiki>+/-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>+/-</nowiki> | ||
|Hx of [[Seizure|seizures]] | |||
|prolactin level | |||
|<nowiki>+/- mass lesion</nowiki> | |||
|[[EEG]] <ref name="pmid11385043">{{cite journal| author=Manford M| title=Assessment and investigation of possible epileptic seizures. | journal=J Neurol Neurosurg Psychiatry | year= 2001 | volume= 70 Suppl 2 | issue= | pages= II3-8 | pmid=11385043 | doi= | pmc=1765557 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11385043 }}</ref> | |||
|- | |- | ||
|Meningitis | |[[Meningitis]] | ||
| | |<nowiki>+</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>+</nowiki> | ||
| | |<nowiki>+/-</nowiki> | ||
| | |<nowiki>+/-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>+/-</nowiki> | ||
| | |<nowiki>+/-</nowiki> | ||
| | |<nowiki>+</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>+</nowiki> | ||
|Hx of [[fever]], [[malaise]] | |||
|[[Leukocytosis|<math>\uparrow</math>WBC]] | |||
<math>\uparrow</math>Protein | |||
<math>\downarrow</math>glucose | |||
|<nowiki>+/-</nowiki> | |||
|[[CSF analysis]]<ref name="pmid19398286">{{cite journal| author=Carbonnelle E| title=[Laboratory diagnosis of bacterial meningitis: usefulness of various tests for the determination of the etiological agent]. | journal=Med Mal Infect | year= 2009 | volume= 39 | issue= 7-8 | pages= 581-605 | pmid=19398286 | doi=10.1016/j.medmal.2009.02.017 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19398286 }}</ref> | |||
|- | |- | ||
|Encephalitis | |[[Encephalitis]] | ||
| | |<nowiki>+</nowiki> | ||
| | |<nowiki>+/-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>+</nowiki> | ||
| | |<nowiki>+/-</nowiki> | ||
| | |<nowiki>+/-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>+/-</nowiki> | ||
| | |<nowiki>+</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>+</nowiki> | ||
|Hx of [[fever]], [[malaise]] | |||
|elevated WBC, low glucose | |||
|<nowiki>+</nowiki> | |||
|CSF PCR | |||
|- | |- | ||
|[[Brain tumor]] | |[[Brain tumor]]<ref name="pmid10582668">{{cite journal| author=Morgenstern LB, Frankowski RF| title=Brain tumor masquerading as stroke. | journal=J Neurooncol | year= 1999 | volume= 44 | issue= 1 | pages= 47-52 | pmid=10582668 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10582668 }}</ref> | ||
| | |<nowiki>+</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>+/-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>+/-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>+/-</nowiki> | ||
| | |<nowiki>+/-</nowiki> | ||
|[[weight loss]], [[fatigue]] | |||
|neuromarkers, | |||
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> | |||
|<nowiki>+/- mass</nowiki> | |||
|[[MRI]] | |||
|- | |- | ||
|[[Subdural hematoma|Subdural hemorrhage]] | |[[Subdural hematoma|Subdural hemorrhage]] | ||
| | |<nowiki>-/+</nowiki> | ||
| | |<nowiki>+/-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>+/-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>+/-</nowiki> | ||
| | |<nowiki>+/-</nowiki> | ||
|[[Trauma]], [[fall]] | |||
|Xanthochromia | |||
|<nowiki>+</nowiki> | |||
|CT w/o contrast | |||
|- | |- | ||
|Subarachnoid hemorrhage | |[[Subarachnoid hemorrhage]] | ||
| | | -/+ | ||
| | |<nowiki>+/-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>+/-</nowiki> | ||
| | |<nowiki>+/-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>+/-</nowiki> | ||
| | |<nowiki>+/-</nowiki> | ||
| | |<nowiki>+/-</nowiki> | ||
|[[thunderclap headache]] | |||
|<math>\uparrow</math>opening pressure, xanthochromia | |||
|<nowiki>+</nowiki> | |||
|CT w/o contrast | |||
|- | |- | ||
|Hypertensive encephalopathy | |[[Hypertensive encephalopathy]] | ||
| | |<nowiki>+</nowiki> | ||
| | |<nowiki>+/-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>+/-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>+/-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
|[[Hypertension]] | |||
|UA +/- | |||
|<nowiki>+/-</nowiki> | |||
|clinical assessment | |||
|- | |- | ||
|[[Brain abscess|CNS abscess]] | |[[Brain abscess|CNS abscess]] | ||
| | |<nowiki>-/+</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>+</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>+/-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>+/-</nowiki> | ||
| | |<nowiki>+/-</nowiki> | ||
| | |<nowiki>+/-</nowiki> | ||
| | |<nowiki>+/-</nowiki> | ||
| | |<nowiki>+/-</nowiki> | ||
|History of [[drug abuse]], [[endocarditis]], [[immunosupression]] | |||
|'''↑''' [[Leukocytosis|leukocytes]], '''↓''' [[glucose]] and '''↑''' protien | |||
|<nowiki>+</nowiki> | |||
|[[MRI]] | |||
|- | |- | ||
|[[Conversion disorder]] | |[[Conversion disorder]] | ||
| | |<nowiki>-/+</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>+/-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>+/-</nowiki> | ||
| | |<nowiki>+/-</nowiki> | ||
| | |<nowiki>+/-</nowiki> | ||
|History of [[emotional stress]] | |||
|<nowiki>-</nowiki> | |||
| - | |||
|Diagnosis of exclusion | |||
|- | |- | ||
|[[Multiple sclerosis]] | |[[Multiple sclerosis]] | ||
| | |<nowiki>-/+</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>+</nowiki> | ||
| | |<nowiki>+/-</nowiki> | ||
|History of relapses and remissions | |||
|'''↑''' [[CSF]] [[IgG]] levels | |||
(monoclonal bands) | |||
|<nowiki>+</nowiki> | |||
|[[MRI]] | |||
|- | |- | ||
|[[Hemorrhagic stroke]] | |[[Hemorrhagic stroke]] | ||
| | |<nowiki>-/+</nowiki> | ||
| | |<nowiki>+/-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>+/-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>+/-</nowiki> | ||
| | |<nowiki>+/-</nowiki> | ||
|[[Hypertension|HTN]] | |||
|<nowiki>-</nowiki> | |||
|<nowiki>+</nowiki> | |||
|[[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> | |||
|- | |- | ||
|[[Neurosyphilis]] | |[[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> | ||
| | |<nowiki>-/+</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>+/-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>+/-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>+/-</nowiki> | ||
| | |<nowiki>+/-</nowiki> | ||
|[[Sexually transmitted disease|STI]]<nowiki/>s | |||
|'''↑''' [[Leukocytes]] and [[protein]] | |||
|<nowiki>+</nowiki> | |||
|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> | |||
|- | |- | ||
|[[Wernicke's encephalopathy|Wernicke’s encephalopathy]] | |[[Wernicke's encephalopathy|Wernicke’s encephalopathy]] | ||
| | |<nowiki>-/+</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>+/-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>+/-</nowiki> | ||
| | |<nowiki>+/-</nowiki> | ||
|History of alcohal abuse | |||
|blood ethanol levels | |||
|<nowiki>+/-</nowiki> | |||
|Clinical assesment and lab findings | |||
|- | |- | ||
|[[Drug toxicity]] | |[[Drug toxicity]] | ||
| | |<nowiki>-/+</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>+/-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>+/-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>+/-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>+/-</nowiki> | ||
| | |<nowiki>+/-</nowiki> | ||
| | |<nowiki>+/-</nowiki> | ||
|Medication hx | |||
|Drug levels | |||
|<nowiki>-</nowiki> | |||
|Drug screen test | |||
|- | |||
|[[Metabolic disorder|Metabolic disturbances]] | |||
|<nowiki>-/+</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>+/-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>+/-</nowiki> | |||
|<nowiki>+/-</nowiki> | |||
|Underlying [[CKD]], CLD | |||
|[[Hypoglycemia]], [[Hyponatremia|hypo]] and [[hypernatremia]], [[Hypokalemia|hypo]] and [[hyperkalemia]] | |||
|<nowiki>-</nowiki> | |||
|Cause dependent | |||
|- | |||
|[[Sinusitis]] | |||
|<nowiki>-/+</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>+/-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|[[allergies]], seasonal | |||
|[[leukocytosis]] | |||
|<nowiki>+</nowiki> | |||
|[[CT-scans|CT]] | |||
|} | |||
</small></small> | |||
==Diagnsotic Labs For Meningitis== | |||
Diagnosis of meningitis, is based on clinical presentation in combination with CSF analysis. CSF analysis has major role for diagnosis and rule out other possibilities. The following table summarizes the CSF findings in different types of meningitis.<ref name="pmid23717798">{{cite journal| author=Le Rhun E, Taillibert S, Chamberlain MC| title=Carcinomatous meningitis: Leptomeningeal metastases in solid tumors. | journal=Surg Neurol Int | year= 2013 | volume= 4 | issue= Suppl 4 | pages= S265-88 | pmid=23717798 | doi=10.4103/2152-7806.111304 | pmc=3656567 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23717798 }} </ref><ref name="pmid24326618">{{cite journal| author=Chow E, Troy SB| title=The differential diagnosis of hypoglycorrhachia in adult patients. | journal=Am J Med Sci | year= 2014 | volume= 348 | issue= 3 | pages= 186-90 | pmid=24326618 | doi=10.1097/MAJ.0000000000000217 | pmc=4065645 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24326618 }} </ref><ref name="pmid22880096">{{cite journal| author=Leen WG, Willemsen MA, Wevers RA, Verbeek MM| title=Cerebrospinal fluid glucose and lactate: age-specific reference values and implications for clinical practice. | journal=PLoS One | year= 2012 | volume= 7 | issue= 8 | pages= e42745 | pmid=22880096 | doi=10.1371/journal.pone.0042745 | pmc=3412827 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22880096 }} </ref><ref name="pmid10654948">{{cite journal| author=Negrini B, Kelleher KJ, Wald ER| title=Cerebrospinal fluid findings in aseptic versus bacterial meningitis. | journal=Pediatrics | year= 2000 | volume= 105 | issue= 2 | pages= 316-9 | pmid=10654948 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10654948 }} </ref><ref name="pmid20610819">{{cite journal| author=Brouwer MC, Tunkel AR, van de Beek D| title=Epidemiology, diagnosis, and antimicrobial treatment of acute bacterial meningitis. | journal=Clin Microbiol Rev | year= 2010 | volume= 23 | issue= 3 | pages= 467-92 | pmid=20610819 | doi=10.1128/CMR.00070-09 | pmc=2901656 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20610819 }} </ref> | |||
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center | |||
|+ | |||
! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF|Cerebrospinal fluid level}} | |||
! style="background: #4479BA; width: 350px;" | {{fontcolor|#FFF|Normal level}} | |||
! style="background: #4479BA; width: 350px;" | {{fontcolor|#FFF|Bacterial meningitis}}<ref name="pmid10654948">{{cite journal| author=Negrini B, Kelleher KJ, Wald ER| title=Cerebrospinal fluid findings in aseptic versus bacterial meningitis. | journal=Pediatrics | year= 2000 | volume= 105 | issue= 2 | pages= 316-9 | pmid=10654948 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10654948 }} </ref> | |||
! style="background: #4479BA; width: 350px;" | {{fontcolor|#FFF|Viral meningitis}}<ref name="pmid10654948">{{cite journal| author=Negrini B, Kelleher KJ, Wald ER| title=Cerebrospinal fluid findings in aseptic versus bacterial meningitis. | journal=Pediatrics | year= 2000 | volume= 105 | issue= 2 | pages= 316-9 | pmid=10654948 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10654948 }} </ref> | |||
! style="background: #4479BA; width: 350px;" | {{fontcolor|#FFF|Fungal meningitis}} | |||
! style="background: #4479BA; width: 350px;" | {{fontcolor|#FFF|Tuberculous meningitis}}<ref name="pmid20146981">{{cite journal| author=Caudie C, Tholance Y, Quadrio I, Peysson S| title=[Contribution of CSF analysis to diagnosis and follow-up of tuberculous meningitis]. | journal=Ann Biol Clin (Paris) | year= 2010 | volume= 68 | issue= 1 | pages= 107-11 | pmid=20146981 | doi=10.1684/abc.2010.0407 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20146981 }} </ref> | |||
! style="background: #4479BA; width: 350px;" | {{fontcolor|#FFF|Neoplastic meningitis}}<ref name="pmid23717798">{{cite journal| author=Le Rhun E, Taillibert S, Chamberlain MC| title=Carcinomatous meningitis: Leptomeningeal metastases in solid tumors. | journal=Surg Neurol Int | year= 2013 | volume= 4 | issue= Suppl 4 | pages= S265-88 | pmid=23717798 | doi=10.4103/2152-7806.111304 | pmc=3656567 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23717798 }} </ref> | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;" | '''Cells/ul''' | |||
| style="padding: 5px 5px; background: #F5F5F5;" |'''< 5''' | |||
| style="padding: 5px 5px; background: #F5F5F5;" |'''>300''' | |||
| style="padding: 5px 5px; background: #F5F5F5;" |'''10-1000''' | |||
| style="padding: 5px 5px; background: #F5F5F5;" |'''10-500''' | |||
| style="padding: 5px 5px; background: #F5F5F5;" |'''50-500''' | |||
| style="padding: 5px 5px; background: #F5F5F5;" |'''>4''' | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;" |'''Cells''' | |||
| style="padding: 5px 5px; background: #F5F5F5;" |'''[[Lymphocyte]]''' | |||
| style="padding: 5px 5px; background: #F5F5F5;" |'''[[Leukocyte]] > [[Lymphocyte]]''' | |||
| style="padding: 5px 5px; background: #F5F5F5;" |'''[[Lymphocyte]] > [[Leukocyte]]''' | |||
| style="padding: 5px 5px; background: #F5F5F5;" |'''[[Lymphocyte]] > [[Leukocyte]]''' | |||
| style="padding: 5px 5px; background: #F5F5F5;" |'''[[Lymphocyte]] > [[Leukocyte]]''' | |||
| style="padding: 5px 5px; background: #F5F5F5;" |'''[[Lymphocyte]] > [[Leukocyte]]''' | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;" |'''Total protein (mg/dl''') | |||
| style="padding: 5px 5px; background: #F5F5F5;" |'''45-60''' | |||
| style="padding: 5px 5px; background: #F5F5F5;" |'''Typically 100-500''' | |||
| style="padding: 5px 5px; background: #F5F5F5;" | '''Normal or slightly high''' | |||
| style="padding: 5px 5px; background: #F5F5F5;" |'''High''' | |||
| style="padding: 5px 5px; background: #F5F5F5;" |'''Typically 100-200''' | |||
| style="padding: 5px 5px; background: #F5F5F5;" |'''>50''' | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;" |'''Glucose ratio (CSF/plasma)<ref name="pmid24326618">{{cite journal| author=Chow E, Troy SB| title=The differential diagnosis of hypoglycorrhachia in adult patients. | journal=Am J Med Sci | year= 2014 | volume= 348 | issue= 3 | pages= 186-90 | pmid=24326618 | doi=10.1097/MAJ.0000000000000217 | pmc=4065645 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24326618 }} </ref>''' | |||
| style="padding: 5px 5px; background: #F5F5F5;" |'''> 0.5''' | |||
| style="padding: 5px 5px; background: #F5F5F5;" |'''< 0.3''' | |||
| style="padding: 5px 5px; background: #F5F5F5;" |'''> 0.6''' | |||
| style="padding: 5px 5px; background: #F5F5F5;" |'''<0.3''' | |||
| style="padding: 5px 5px; background: #F5F5F5;" |'''< 0.5''' | |||
| style="padding: 5px 5px; background: #F5F5F5;" |'''<0.5''' | |||
|- | |- | ||
| | | style="padding: 5px 5px; background: #DCDCDC;" |'''Lactate (mmols/l)<ref name="pmid22880096">{{cite journal| author=Leen WG, Willemsen MA, Wevers RA, Verbeek MM| title=Cerebrospinal fluid glucose and lactate: age-specific reference values and implications for clinical practice. | journal=PLoS One | year= 2012 | volume= 7 | issue= 8 | pages= e42745 | pmid=22880096 | doi=10.1371/journal.pone.0042745 | pmc=3412827 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22880096 }} </ref>''' | ||
| | | style="padding: 5px 5px; background: #F5F5F5;" |'''< 2.1''' | ||
| | | style="padding: 5px 5px; background: #F5F5F5;" |'''> 2.1''' | ||
| | | style="padding: 5px 5px; background: #F5F5F5;" |'''< 2.1''' | ||
| | | style="padding: 5px 5px; background: #F5F5F5;" |'''>3.2''' | ||
| | | style="padding: 5px 5px; background: #F5F5F5;" |'''> 2.1''' | ||
| | | style="padding: 5px 5px; background: #F5F5F5;" |'''>2.1''' | ||
| | |||
| | |||
| | |||
| | |||
| | |||
| | |||
| | |||
|- | |- | ||
| | | style="padding: 5px 5px; background: #DCDCDC;" |'''Others''' | ||
| | | style="padding: 5px 5px; background: #F5F5F5;" |'''[[Intracranial pressure|Intra-cranial pressure]] (ICP) = 6-12 (cm H2O)''' | ||
| | | style="padding: 5px 5px; background: #F5F5F5;" |'''CSF [[gram stain]], CSF culture, CSF bacterial antigen''' | ||
| | | style="padding: 5px 5px; background: #F5F5F5;" |'''[[PCR]] of HSV-DNA, VZV''' | ||
| | | style="padding: 5px 5px; background: #F5F5F5;" |'''CSF [[gram stain]], CSF india ink''' | ||
| | | style="padding: 5px 5px; background: #F5F5F5;" |'''[[PCR]] of TB-DNA''' | ||
| | | style="padding: 5px 5px; background: #F5F5F5;" |'''CSF tumour markers such as [[Alpha-fetoprotein|alpha fetoprotein]], [[CEA]]''' | ||
| | |||
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| | |||
| | |||
| | |||
|- | |- | ||
|} | |} | ||
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==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
{{WikiDoc Help Menu}} | |||
{{WikiDoc Sources}} | |||
[[Category:Headaches]] | [[Category:Headaches]] | ||
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[[Category:Neurology]] | [[Category:Neurology]] | ||
[[Category:Emergency medicine]] | [[Category:Emergency medicine]] | ||
[[Category:Needs content]] | [[Category:Needs content]] | ||
Latest revision as of 21:58, 29 July 2020
For the WikiDoc page for this topic, click here Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sabeeh Islam, MBBS[2]
Differential diagnosis of headache includes: Migraine, tension-type headache, cluster headache, seizure, meningitis, encephalitis, neurosyphilis, SAH, subdural hematoma, brain tumor, hypertensive encephalopathy, brain abscess, multiple sclerosis, hemorrhagic stroke, Wernickes encephalopathy, and drug toxicity etc.[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]
| Disease | History and Physical Examination | PMHx | Diagnostic approach | ||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Bilateral | Throbbing character | Autonomic symptoms | Fever | Photophobia | Aphasia | LOC | Aura | Nause/
Vomiting |
Rash | Neck stiffness | Vision changes | Neurologic deficits | Labs and CSF findings | CT/MRI | Gold standard test | ||
| Migraine | - | + | - | - | + | - | - | + | + | - | - | + | - | Trigger factors, family hx | - | - | Clinical assesment |
| Tension-type headache (TTH) | + | - | - | - | - | - | - | - | - | - | - | - | - | stress, genetics | - | - | Clinical assesment |
| Cluster headache | - | - | + | - | - | - | - | - | - | - | - | + | - | episodic history | - | - | Clinical assesment |
| Seizure | + | - | - | - | - | +/- | + | +/- | - | - | - | - | +/- | Hx of seizures | prolactin level | +/- mass lesion | EEG [20] |
| Meningitis | + | - | - | + | +/- | +/- | - | - | +/- | +/- | + | - | + | Hx of fever, malaise | <math>\uparrow</math>WBC
<math>\uparrow</math>Protein <math>\downarrow</math>glucose |
+/- | CSF analysis[21] |
| Encephalitis | + | +/- | - | + | +/- | +/- | - | - | - | +/- | + | - | + | Hx of fever, malaise | elevated WBC, low glucose | + | CSF PCR |
| Brain tumor[22] | + | - | - | - | - | +/- | - | - | +/- | - | - | +/- | +/- | weight loss, fatigue | neuromarkers,
Cancer cells[23] |
+/- mass | MRI |
| Subdural hemorrhage | -/+ | +/- | - | - | - | +/- | - | - | - | - | - | +/- | +/- | Trauma, fall | Xanthochromia | + | CT w/o contrast |
| Subarachnoid hemorrhage | -/+ | +/- | - | - | +/- | +/- | - | - | - | - | +/- | +/- | +/- | thunderclap headache | <math>\uparrow</math>opening pressure, xanthochromia | + | CT w/o contrast |
| Hypertensive encephalopathy | + | +/- | - | - | +/- | - | - | - | - | - | - | +/- | - | Hypertension | UA +/- | +/- | clinical assessment |
| CNS abscess | -/+ | - | - | + | - | +/- | - | - | +/- | +/- | +/- | +/- | +/- | History of drug abuse, endocarditis, immunosupression | ↑ leukocytes, ↓ glucose and ↑ protien | + | MRI |
| Conversion disorder | -/+ | - | - | - | - | +/- | - | - | - | - | +/- | +/- | +/- | History of emotional stress | - | - | Diagnosis of exclusion |
| Multiple sclerosis | -/+ | - | - | - | - | - | - | - | - | - | - | + | +/- | History of relapses and remissions | ↑ CSF IgG levels
(monoclonal bands) |
+ | MRI |
| Hemorrhagic stroke | -/+ | +/- | - | - | - | +/- | - | - | - | - | - | +/- | +/- | HTN | - | + | CT scan without contrast[24][25] |
| Neurosyphilis[26][27] | -/+ | - | - | - | - | - | +/- | - | - | +/- | - | +/- | +/- | STIs | ↑ Leukocytes and protein | + | CSF VDRL-specifc
CSF FTA-Ab -sensitive[28] |
| Wernicke’s encephalopathy | -/+ | - | - | - | - | +/- | - | - | - | - | - | +/- | +/- | History of alcohal abuse | blood ethanol levels | +/- | Clinical assesment and lab findings |
| Drug toxicity | -/+ | - | - | +/- | - | - | +/- | - | +/- | - | +/- | +/- | +/- | Medication hx | Drug levels | - | Drug screen test |
| Metabolic disturbances | -/+ | - | - | - | - | - | - | - | +/- | - | - | +/- | +/- | Underlying CKD, CLD | Hypoglycemia, hypo and hypernatremia, hypo and hyperkalemia | - | Cause dependent |
| Sinusitis | -/+ | - | - | +/- | - | - | - | - | - | - | - | - | - | allergies, seasonal | leukocytosis | + | CT |
Diagnsotic Labs For Meningitis
Diagnosis of meningitis, is based on clinical presentation in combination with CSF analysis. CSF analysis has major role for diagnosis and rule out other possibilities. The following table summarizes the CSF findings in different types of meningitis.[2][3][4][5][6]
| Cerebrospinal fluid level | Normal level | Bacterial meningitis[5] | Viral meningitis[5] | Fungal meningitis | Tuberculous meningitis[29] | Neoplastic meningitis[2] |
|---|---|---|---|---|---|---|
| Cells/ul | < 5 | >300 | 10-1000 | 10-500 | 50-500 | >4 |
| Cells | Lymphocyte | Leukocyte > Lymphocyte | Lymphocyte > Leukocyte | Lymphocyte > Leukocyte | Lymphocyte > Leukocyte | Lymphocyte > Leukocyte |
| Total protein (mg/dl) | 45-60 | Typically 100-500 | Normal or slightly high | High | Typically 100-200 | >50 |
| Glucose ratio (CSF/plasma)[3] | > 0.5 | < 0.3 | > 0.6 | <0.3 | < 0.5 | <0.5 |
| Lactate (mmols/l)[4] | < 2.1 | > 2.1 | < 2.1 | >3.2 | > 2.1 | >2.1 |
| Others | Intra-cranial pressure (ICP) = 6-12 (cm H2O) | CSF gram stain, CSF culture, CSF bacterial antigen | PCR of HSV-DNA, VZV | CSF gram stain, CSF india ink | PCR of TB-DNA | CSF tumour markers such as alpha fetoprotein, CEA |
References
- ↑ "National guidelines for analysis of cerebrospinal fluid for bilirubin in suspected subarachnoid haemorrhage". Ann. Clin. Biochem. 40 (Pt 5): 481–8. September 2003. doi:10.1258/000456303322326399. PMID 14503985.
- ↑ 2.0 2.1 2.2 Le Rhun E, Taillibert S, Chamberlain MC (2013). "Carcinomatous meningitis: Leptomeningeal metastases in solid tumors". Surg Neurol Int. 4 (Suppl 4): S265–88. doi:10.4103/2152-7806.111304. PMC 3656567. PMID 23717798.
- ↑ 3.0 3.1 3.2 Chow E, Troy SB (2014). "The differential diagnosis of hypoglycorrhachia in adult patients". Am J Med Sci. 348 (3): 186–90. doi:10.1097/MAJ.0000000000000217. PMC 4065645. PMID 24326618.
- ↑ 4.0 4.1 4.2 Leen WG, Willemsen MA, Wevers RA, Verbeek MM (2012). "Cerebrospinal fluid glucose and lactate: age-specific reference values and implications for clinical practice". PLoS One. 7 (8): e42745. doi:10.1371/journal.pone.0042745. PMC 3412827. PMID 22880096.
- ↑ 5.0 5.1 5.2 5.3 Negrini B, Kelleher KJ, Wald ER (2000). "Cerebrospinal fluid findings in aseptic versus bacterial meningitis". Pediatrics. 105 (2): 316–9. PMID 10654948.
- ↑ 6.0 6.1 Brouwer MC, Tunkel AR, van de Beek D (2010). "Epidemiology, diagnosis, and antimicrobial treatment of acute bacterial meningitis". Clin Microbiol Rev. 23 (3): 467–92. doi:10.1128/CMR.00070-09. PMC 2901656. PMID 20610819.
- ↑ Vermeulen M, Hasan D, Blijenberg BG, Hijdra A, van Gijn J (July 1989). "Xanthochromia after subarachnoid haemorrhage needs no revisitation". J. Neurol. Neurosurg. Psychiatry. 52 (7): 826–8. doi:10.1136/jnnp.52.7.826. PMC 1031927. PMID 2769274.
- ↑ Wasay M, Mekan SF, Khelaeni B, Saeed Z, Hassan A, Cheema Z, Bakshi R (June 2005). "Extra temporal involvement in herpes simplex encephalitis". Eur. J. Neurol. 12 (6): 475–9. doi:10.1111/j.1468-1331.2005.00999.x. PMID 15885053.
- ↑ Glaser CA, Honarmand S, Anderson LJ, Schnurr DP, Forghani B, Cossen CK, Schuster FL, Christie LJ, Tureen JH (December 2006). "Beyond viruses: clinical profiles and etiologies associated with encephalitis". Clin. Infect. Dis. 43 (12): 1565–77. doi:10.1086/509330. PMID 17109290.
- ↑ Meltzer EO, Hamilos DL (May 2011). "Rhinosinusitis diagnosis and management for the clinician: a synopsis of recent consensus guidelines". Mayo Clin. Proc. 86 (5): 427–43. doi:10.4065/mcp.2010.0392. PMC 3084646. PMID 21490181.
- ↑ Rasmussen BK, Jensen R, Schroll M, Olesen J (1991). "Epidemiology of headache in a general population--a prevalence study". J Clin Epidemiol. 44 (11): 1147–57. doi:10.1016/0895-4356(91)90147-2. PMID 1941010.
- ↑ Kelman L (October 2004). "The premonitory symptoms (prodrome): a tertiary care study of 893 migraineurs". Headache. 44 (9): 865–72. doi:10.1111/j.1526-4610.2004.04168.x. PMID 15447695.
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