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	Meningitis Main Page
Patient Information
Overview
Causes
Classification Viral Meningitis Bacterial Meningitis Fungal Meningitis
Differential Diagnosis
Diagnosis
Treatment

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Revision as of 16:07, 26 April 2017

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

Overview

Causes

Etiology	Common causes	Less common causes
Bacterial	Streptococcus pneumoniae Neisseria meningitis Hemophilus influenza Group B streptococcus Listeria monocytogenes	Staphylococcus aureus Klebsiella Pseudomonas E. coli Kingella Kingae Mycobacterium tuberculosis Diphtheroids Propionibacterium acnes Serratia marcescens Salmonella species Brucella sp Nocardia Francisella tularensis Streptococcus suis Ehrlichia chaffeensis
Viral	Enteroviruses Herpes simplex viruses 1 and 2 Arboviruses	Influenza virus Herpes zoster Human Herpes Virus 6 Epstein barr virus (EBV) Lymphocytic choriomeningitis virus Mumps Cytomegalo virus (CMV) Human immunodeficiency virus (HIV) West nile virus Human T cell lymphotrophic virus I and II Varicella zoster virus
Fungal	Cryptococcus neoformans Aspergillus sp. Blastomyces dermatitidis Coccidioides immitis Candida spp. Histoplasma capsulatum Sporothrix schencki	Xylohypha (formerly Cladosporium) trichoides and other dark-walled (demateaceous) fungi such as Curvularia and Drechslera Mucor Arthrographis kalrae Pneumocystis jirovecii^[1]^[2] Cryptococcus albidus^[3] Alternaria spp^[4] Rhodotorula spp ^[5] Acremonium spp.^[6] Dreschlera spp^[7] Malassezia spp^[8] Scedosporium spp^[9] Arthrographis spp^[10] Blastoschizomyces^[11]^[12] Paecilomyces^[13]^[14] Aureobasidium^[15] Clavispora^[16] Ustilago^[17] Exophiala (Wangiella)^[18] Exserohilum^[19]
Spirochetal	Treponema pallidum Borrelia burgdoferi	--
Protozoal and Helminthic	Amebas (Naegleria, Acanthamoeba, and Balamuthia)	Angiostrongylus cantonensis Gnathostoma species Baylisascaris procyonis Toxocara species Taenia solium
Noninfectious conditions	Neoplastic Sarcoidosis Systemic lupus erythematosus Granulomatosis with polyangiitis (Wegener's) Behçet's disease	Fabry disease Central nervous system vasculitis Vogt-Koyanagi-Harada disease Chemical or drug-induced meningitis Nonsteroidal antiinflammatory drugs Intravenous immunoglobulin Intrathecal agents Certain antibiotics (eg, trimethoprim-sulfamethoxazole)

Classification

Meningitis could be classified to two main groups based on etiology:

Infectious
Non-infectious

Infectious meningitis

Infectious meningitis may be classified as the following algorithm based on chronicity of symptoms.

Infectious Meningitis

Viral

Bacterial

Fungal

Acute

Chronic

Recurrent

Acute

Subacute

Chronic

Recurrent

Non-infectious meningitis

Systemic illnesses, such as malignancies and connective tissue diseases (e.g. sarcoidosis, SLE, and wegener's) may involve meninges in their course and present as chronic meningitis.

Certain drugs may cause meningeal irritation and resemble as meningitis including:

Nonsteroidal antiinflammatory drugs (NSAIDs)
Intravenous immunoglobulin
Intrathecal agents
Certain antibiotics (eg, trimethoprim-sulfamethoxazole)

Differential diagnosis

Diseases	Symptoms				Physical Examination					Past medical history	Diagnostic tests			Other Findings
Diseases	Headache	↓LOC	Motor weakness	Abnormal sensory	Motor Deficit	Sensory deficit	Speech difficulty	Gait abnormality	Cranial nerves	Past medical history	CT /MRI	CSF Findings	Gold standard test	Other Findings
Brain tumor^[20]	+	-	-	-	+	+	+	-	+	Weight loss, fatigue	+	Cancer cells^[21]	MRI	Cachexia, gradual progression of symptoms
Hemorrhagic stroke	+	+	+	+	+	+	+	+	-	Hypertension	+	-	CT scan without contrast^[22]^[23]	Neck stiffness
Subdural hemorrhage	+	+	+	+	+	-	-	-	+	Trauma, fall	+	Xanthochromia^[24]	CT scan without contrast^[22]^[23]	Confusion, dizziness, nausea, vomiting
Neurosyphilis^[25]^[26]	+	-	+	+	+	+	-	+	-	STIs	+	↑ Leukocytes and protein	CSF VDRL-specifc CSF FTA-Ab -sensitive^[27]	Blindness, confusion, depression, Abnormal gait
Complex or atypical migraine	+	-	+	+	-	-	+	-	-	Family history of migraine	-	-	Clinical assesment	Presence of aura, nausea, vomiting
Hypertensive encephalopathy	+	+	-	-	-	-	+	+	-	Hypertension	+	-	Clinical assesment	Delirium, cortical blindness, cerebral edema, seizure
Wernicke’s encephalopathy	-	+	-	-	-	+	+	+	+	History of alcohal abuse	-	-	Clinical assesment and lab findings	Ophthalmoplegia, confusion
CNS abscess	+	+	-	-	+	+	+	-	-	History of drug abuse, endocarditis, immunosupression	+	↑ leukocytes, ↓ glucose and ↑ protien	MRI is more sensitive and specific	High grade fever, fatigue,nausea, vomiting
Drug toxicity	-	+	-	+	+	+	-	+	-	-	-	-	Drug screen test	Lithium, Sedatives, phenytoin, carbamazepine
Conversion disorder	+	+	+	+	+	+	+	+		History of emotional stress	-	-	Diagnosis of exclusion	Tremors, blindness, difficulty swallowing
Metabolic disturbances (electrolyte imbalance, hypoglycemia)	-	+	+	+	+	+	-	-	+	-	-	Hypoglycemia, hypo and hypernatremia, hypo and hyperkalemia	Depends on the cause	Confusion, seizure, palpitations, sweating, dizziness, hypoglycemia
Meningitis or encephalitis	+	-	-	-	-	+	+	-	-	History of fever and malaise	-	↑ Leukocytes, ↑ Protein ↓ Glucose	CSF analysis^[28]	Fever, neck rigidity
Multiple sclerosis exacerbation	-	-	+	+	-	+	+	+	+	History of relapses and remissions	+	↑ CSF IgG levels (monoclonal bands)	Clinical assesment and MRI ^[29]	Blurry vision, urinary incontinence, fatigue
Seizure	+	+	-	-	+	+	-	-	+	Previous history of seizures	-	Mass lesion	Clinical assesment and EEG ^[30]	Confusion, apathy, irritability,

Diagnosis

References

↑ Villanueva JL, Cordero E, Caballero-Granado FJ, Regordan C, Becerril B, Pachón J (1997). "Pneumocystis carinii meningoradiculitis in a patient with AIDS". Eur J Clin Microbiol Infect Dis. 16 (12): 940–2. PMID 9495679.
↑ Baena Luna MR, Muñoz García J, Grancha Bertolín L, Sanz García M (1998). "[Presence of Pneumocystis carinii in cerebrospinal fluid]". An Med Interna. 15 (5): 265–6. PMID 9629775.
↑ Melo JC, Srinivasan S, Scott ML, Raff MJ (1980). "Cryptococcus albidus meningitis". J Infect. 2 (1): 79–82. PMID 7185917.
↑ OHASHI Y (1960). "On a rare disease due to Alternaria tenuis Nees (alternariasis)". Tohoku J Exp Med. 72: 78–82. PMID 13730495.
↑ Shinde RS, Mantur BG, Patil G, Parande MV, Parande AM (2008). "Meningitis due to Rhodotorula glutinis in an HIV infected patient". Indian J Med Microbiol. 26 (4): 375–7. PMID 18974495.
↑ Fincher RM, Fisher JF, Lovell RD, Newman CL, Espinel-Ingroff A, Shadomy HJ (1991). "Infection due to the fungus Acremonium (cephalosporium)". Medicine (Baltimore). 70 (6): 398–409. PMID 1956281.
↑ Fuste FJ, Ajello L, Threlkeld R, Henry JE (1973). "Drechslera hawaiiensis: causative agent of a fatal fungal meningo-encephalitis". Sabouraudia. 11 (1): 59–63. PMID 4739938.
↑ Rosales CM, Jackson MA, Zwick D (2004). "Malassezia furfur meningitis associated with total parenteral nutrition subdural effusion". Pediatr Dev Pathol. 7 (1): 86–90. doi:10.1007/s10024-003-4030-5. PMID 15255040.
↑ Symoens F, Knoop C, Schrooyen M, Denis O, Estenne M, Nolard N; et al. (2006). "Disseminated Scedosporium apiospermum infection in a cystic fibrosis patient after double-lung transplantation". J Heart Lung Transplant. 25 (5): 603–7. doi:10.1016/j.healun.2005.12.011. PMID 16678041.
↑ Chin-Hong PV, Sutton DA, Roemer M, Jacobson MA, Aberg JA (2001). "Invasive fungal sinusitis and meningitis due to Arthrographis kalrae in a patient with AIDS". J Clin Microbiol. 39 (2): 804–7. doi:10.1128/JCM.39.2.804-807.2001. PMC 87827. PMID 11158158.
↑ Girmenia C, Micozzi A, Venditti M, Meloni G, Iori AP, Bastianello S; et al. (1991). "Fluconazole treatment of Blastoschizomyces capitatus meningitis in an allogeneic bone marrow recipient". Eur J Clin Microbiol Infect Dis. 10 (9): 752–6. PMID 1810730.
↑ Naficy AB, Murray HW (1990). "Isolated meningitis caused by Blastoschizomyces capitatus". J Infect Dis. 161 (5): 1041–2. PMID 2324536.
↑ Kantarcioğlu AS, Hatemi G, Yücel A, De Hoog GS, Mandel NM (2003). "Paecilomyces variotii central nervous system infection in a patient with cancer". Mycoses. 46 (1–2): 45–50. PMID 12588483.
↑ Fagerburg R, Suh B, Buckley HR, Lorber B, Karian J (1981). "Cerebrospinal fluid shunt colonization and obstruction by Paecilomyces variotii. Case report". J Neurosurg. 54 (2): 257–60. doi:10.3171/jns.1981.54.2.0257. PMID 7192726.
↑ Kutleša M, Mlinarić-Missoni E, Hatvani L, Voncina D, Simon S, Lepur D; et al. (2012). "Chronic fungal meningitis caused by Aureobasidium proteae". Diagn Microbiol Infect Dis. 73 (3): 271–2. doi:10.1016/j.diagmicrobio.2012.03.007. PMID 22504065.
↑ Krcmery V, Mateicka F, Grausova S, Kunova A, Hanzen J (1999). "Invasive infections due to Clavispora lusitaniae". FEMS Immunol Med Microbiol. 23 (1): 75–8. PMID 10030550.
↑ MOORE M, RUSSELL WO, SACHS E (1946). "Chronic leptomeningitis and ependymitis caused by Ustilago, probably U. zeae (corn smut)". Am J Pathol. 22: 761–77. PMID 20991975.
↑ Centers for Disease Control and Prevention (CDC) (2002). "Exophiala infection from contaminated injectable steroids prepared by a compounding pharmacy--United States, July-November 2002". MMWR Morb Mortal Wkly Rep. 51 (49): 1109–12. PMID 12530707.
↑ Pettit AC, Pugh ME (2013). "Index case for the fungal meningitis outbreak, United States". N Engl J Med. 368 (10): 970. doi:10.1056/NEJMc1300630. PMID 23465119.
↑ Morgenstern LB, Frankowski RF (1999). "Brain tumor masquerading as stroke". J Neurooncol. 44 (1): 47–52. PMID 10582668.
↑ 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.
↑ ^22.0 ^22.1 Birenbaum D, Bancroft LW, Felsberg GJ (2011). "Imaging in acute stroke". West J Emerg Med. 12 (1): 67–76. PMC 3088377. PMID 21694755.
↑ ^23.0 ^23.1 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.
↑ Lee MC, Heaney LM, Jacobson RL, Klassen AC (1975). "Cerebrospinal fluid in cerebral hemorrhage and infarction". Stroke. 6 (6): 638–41. PMID 1198628.
↑ Liu LL, Zheng WH, Tong ML, Liu GL, Zhang HL, Fu ZG; et al. (2012). "Ischemic stroke as a primary symptom of neurosyphilis among HIV-negative emergency patients". J Neurol Sci. 317 (1–2): 35–9. doi:10.1016/j.jns.2012.03.003. PMID 22482824.
↑ Berger JR, Dean D (2014). "Neurosyphilis". Handb Clin Neurol. 121: 1461–72. doi:10.1016/B978-0-7020-4088-7.00098-5. PMID 24365430.
↑ Ho EL, Marra CM (2012). "Treponemal tests for neurosyphilis--less accurate than what we thought?". Sex Transm Dis. 39 (4): 298–9. doi:10.1097/OLQ.0b013e31824ee574. PMC 3746559. PMID 22421697.
↑ Carbonnelle E (2009). "[Laboratory diagnosis of bacterial meningitis: usefulness of various tests for the determination of the etiological agent]". Med Mal Infect. 39 (7–8): 581–605. doi:10.1016/j.medmal.2009.02.017. PMID 19398286.
↑ Giang DW, Grow VM, Mooney C, Mushlin AI, Goodman AD, Mattson DH; et al. (1994). "Clinical diagnosis of multiple sclerosis. The impact of magnetic resonance imaging and ancillary testing. Rochester-Toronto Magnetic Resonance Study Group". Arch Neurol. 51 (1): 61–6. PMID 8274111.
↑ Manford M (2001). "Assessment and investigation of possible epileptic seizures". J Neurol Neurosurg Psychiatry. 70 Suppl 2: II3–8. PMC 1765557. PMID 11385043.

[pmid9495679-1] Villanueva JL, Cordero E, Caballero-Granado FJ, Regordan C, Becerril B, Pachón J (1997). "Pneumocystis carinii meningoradiculitis in a patient with AIDS". Eur J Clin Microbiol Infect Dis. 16 (12): 940–2. PMID 9495679.

[pmid9629775-2] Baena Luna MR, Muñoz García J, Grancha Bertolín L, Sanz García M (1998). "[Presence of Pneumocystis carinii in cerebrospinal fluid]". An Med Interna. 15 (5): 265–6. PMID 9629775.

[pmid7185917-3] Melo JC, Srinivasan S, Scott ML, Raff MJ (1980). "Cryptococcus albidus meningitis". J Infect. 2 (1): 79–82. PMID 7185917.

[pmid13730495-4] OHASHI Y (1960). "On a rare disease due to Alternaria tenuis Nees (alternariasis)". Tohoku J Exp Med. 72: 78–82. PMID 13730495.

[pmid18974495-5] Shinde RS, Mantur BG, Patil G, Parande MV, Parande AM (2008). "Meningitis due to Rhodotorula glutinis in an HIV infected patient". Indian J Med Microbiol. 26 (4): 375–7. PMID 18974495.

[pmid1956281-6] Fincher RM, Fisher JF, Lovell RD, Newman CL, Espinel-Ingroff A, Shadomy HJ (1991). "Infection due to the fungus Acremonium (cephalosporium)". Medicine (Baltimore). 70 (6): 398–409. PMID 1956281.

[pmid4739938-7] Fuste FJ, Ajello L, Threlkeld R, Henry JE (1973). "Drechslera hawaiiensis: causative agent of a fatal fungal meningo-encephalitis". Sabouraudia. 11 (1): 59–63. PMID 4739938.

[pmid15255040-8] Rosales CM, Jackson MA, Zwick D (2004). "Malassezia furfur meningitis associated with total parenteral nutrition subdural effusion". Pediatr Dev Pathol. 7 (1): 86–90. doi:10.1007/s10024-003-4030-5. PMID 15255040.

[pmid16678041-9] Symoens F, Knoop C, Schrooyen M, Denis O, Estenne M, Nolard N; et al. (2006). "Disseminated Scedosporium apiospermum infection in a cystic fibrosis patient after double-lung transplantation". J Heart Lung Transplant. 25 (5): 603–7. doi:10.1016/j.healun.2005.12.011. PMID 16678041.

[pmid11158158-10] Chin-Hong PV, Sutton DA, Roemer M, Jacobson MA, Aberg JA (2001). "Invasive fungal sinusitis and meningitis due to Arthrographis kalrae in a patient with AIDS". J Clin Microbiol. 39 (2): 804–7. doi:10.1128/JCM.39.2.804-807.2001. PMC 87827. PMID 11158158.

[pmid1810730-11] Girmenia C, Micozzi A, Venditti M, Meloni G, Iori AP, Bastianello S; et al. (1991). "Fluconazole treatment of Blastoschizomyces capitatus meningitis in an allogeneic bone marrow recipient". Eur J Clin Microbiol Infect Dis. 10 (9): 752–6. PMID 1810730.

[pmid2324536-12] Naficy AB, Murray HW (1990). "Isolated meningitis caused by Blastoschizomyces capitatus". J Infect Dis. 161 (5): 1041–2. PMID 2324536.

[pmid12588483-13] Kantarcioğlu AS, Hatemi G, Yücel A, De Hoog GS, Mandel NM (2003). "Paecilomyces variotii central nervous system infection in a patient with cancer". Mycoses. 46 (1–2): 45–50. PMID 12588483.

[pmid7192726-14] Fagerburg R, Suh B, Buckley HR, Lorber B, Karian J (1981). "Cerebrospinal fluid shunt colonization and obstruction by Paecilomyces variotii. Case report". J Neurosurg. 54 (2): 257–60. doi:10.3171/jns.1981.54.2.0257. PMID 7192726.

[pmid22504065-15] Kutleša M, Mlinarić-Missoni E, Hatvani L, Voncina D, Simon S, Lepur D; et al. (2012). "Chronic fungal meningitis caused by Aureobasidium proteae". Diagn Microbiol Infect Dis. 73 (3): 271–2. doi:10.1016/j.diagmicrobio.2012.03.007. PMID 22504065.

[pmid10030550-16] Krcmery V, Mateicka F, Grausova S, Kunova A, Hanzen J (1999). "Invasive infections due to Clavispora lusitaniae". FEMS Immunol Med Microbiol. 23 (1): 75–8. PMID 10030550.

[pmid20991975-17] MOORE M, RUSSELL WO, SACHS E (1946). "Chronic leptomeningitis and ependymitis caused by Ustilago, probably U. zeae (corn smut)". Am J Pathol. 22: 761–77. PMID 20991975.

[pmid12530707-18] Centers for Disease Control and Prevention (CDC) (2002). "Exophiala infection from contaminated injectable steroids prepared by a compounding pharmacy--United States, July-November 2002". MMWR Morb Mortal Wkly Rep. 51 (49): 1109–12. PMID 12530707.

[pmid23465119-19] Pettit AC, Pugh ME (2013). "Index case for the fungal meningitis outbreak, United States". N Engl J Med. 368 (10): 970. doi:10.1056/NEJMc1300630. PMID 23465119.

[pmid10582668-20] Morgenstern LB, Frankowski RF (1999). "Brain tumor masquerading as stroke". J Neurooncol. 44 (1): 47–52. PMID 10582668.

[pmid21371327-21] 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.

[pmid21694755-22] 22.0 ^22.1 Birenbaum D, Bancroft LW, Felsberg GJ (2011). "Imaging in acute stroke". West J Emerg Med. 12 (1): 67–76. PMC 3088377. PMID 21694755.

[pmid21807345-23] 23.0 ^23.1 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.

[pmid1198628-24] Lee MC, Heaney LM, Jacobson RL, Klassen AC (1975). "Cerebrospinal fluid in cerebral hemorrhage and infarction". Stroke. 6 (6): 638–41. PMID 1198628.

[pmid22482824-25] 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.

[pmid24365430-26] Berger JR, Dean D (2014). "Neurosyphilis". Handb Clin Neurol. 121: 1461–72. doi:10.1016/B978-0-7020-4088-7.00098-5. PMID 24365430.

[pmid22421697-27] Ho EL, Marra CM (2012). "Treponemal tests for neurosyphilis--less accurate than what we thought?". Sex Transm Dis. 39 (4): 298–9. doi:10.1097/OLQ.0b013e31824ee574. PMC 3746559. PMID 22421697.

[pmid19398286-28] Carbonnelle E (2009). "[Laboratory diagnosis of bacterial meningitis: usefulness of various tests for the determination of the etiological agent]". Med Mal Infect. 39 (7–8): 581–605. doi:10.1016/j.medmal.2009.02.017. PMID 19398286.

[pmid8274111-29] Giang DW, Grow VM, Mooney C, Mushlin AI, Goodman AD, Mattson DH; et al. (1994). "Clinical diagnosis of multiple sclerosis. The impact of magnetic resonance imaging and ancillary testing. Rochester-Toronto Magnetic Resonance Study Group". Arch Neurol. 51 (1): 61–6. PMID 8274111.

[pmid11385043-30] Manford M (2001). "Assessment and investigation of possible epileptic seizures". J Neurol Neurosurg Psychiatry. 70 Suppl 2: II3–8. PMC 1765557. PMID 11385043.

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@@ Line 158: / Line 158: @@
 * [[Intrathecal]] agents
 * Certain antibiotics (eg, [[Sulfamethoxazole-Trimethoprim|trimethoprim-sulfamethoxazole]])
+==Differential diagnosis==
+{|
+|-style="background: #4479BA; color: #FFFFFF; text-align: center;"
+! rowspan="2" |<small>Diseases</small>
+! colspan="4" |<small>Symptoms
+! colspan="5" |<small>Physical Examination</small>
+! rowspan="2" |<small>Past medical history</small>
+! colspan="3" |<small>Diagnostic tests</small>
+! rowspan="2" |<small>Other Findings</small>
+|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
+!<small>Headache</small>
+!↓<small>LOC</small>
+!<small>Motor weakness</small>
+!<small>Abnormal sensory</small>
+!<small>Motor Deficit</small>
+!<small>Sensory deficit</small>
+!<small>Speech difficulty</small>
+!<small>Gait abnormality</small>
+!<small>Cranial nerves</small>
+!<small>CT /MRI</small>
+!<small>CSF Findings</small>
+!<small>Gold standard test</small>
+|-
+|style="background: #DCDCDC; padding: 5px; text-align: center;" | [[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>
+|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" |[[Weight loss]], [[fatigue]]
+|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;" |[[Cachexia]], gradual progression of symptoms
+|-
+|style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Hemorrhagic 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" | +
+|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" |[[Hypertension]]
+|style="background: #F5F5F5; padding: 5px; text-align:center" | +
+| style="background: #F5F5F5; padding: 5px;" | -
+|style="background: #F5F5F5; padding: 5px;" |CT scan  without contrast<ref name="pmid21694755">{{cite journal| author=Birenbaum D, Bancroft LW, Felsberg GJ| title=Imaging in acute stroke. | journal=West J Emerg Med | year= 2011 | volume= 12 | issue= 1 | pages= 67-76 | pmid=21694755 | doi= | pmc=3088377 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21694755  }}</ref><ref name="pmid21807345">{{cite journal| author=DeLaPaz RL, Wippold FJ, Cornelius RS, Amin-Hanjani S, Angtuaco EJ, Broderick DF et al.| title=ACR Appropriateness Criteria® on cerebrovascular disease. | journal=J Am Coll Radiol | year= 2011 | volume= 8 | issue= 8 | pages= 532-8 | pmid=21807345 | doi=10.1016/j.jacr.2011.05.010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21807345  }}</ref>
+|style="background: #F5F5F5; padding: 5px;" |[[Neck stiffness]]
+|-
+|style="background: #DCDCDC; padding: 5px; text-align: center;" | [[Subdural hematoma|Subdural hemorrhage]]
+|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" |[[Trauma]], fall
+|style="background: #F5F5F5; padding: 5px; text-align:center" | +
+|style="background: #F5F5F5; padding: 5px;" |Xanthochromia<ref name="pmid1198628">{{cite journal| author=Lee MC, Heaney LM, Jacobson RL, Klassen AC| title=Cerebrospinal fluid in cerebral hemorrhage and infarction. | journal=Stroke | year= 1975 | volume= 6 | issue= 6 | pages= 638-41 | pmid=1198628 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1198628  }}</ref>
+|style="background: #F5F5F5; padding: 5px;" |CT scan  without contrast<ref name="pmid21694755">{{cite journal| author=Birenbaum D, Bancroft LW, Felsberg GJ| title=Imaging in acute stroke. | journal=West J Emerg Med | year= 2011 | volume= 12 | issue= 1 | pages= 67-76 | pmid=21694755 | doi= | pmc=3088377 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21694755  }}</ref><ref name="pmid21807345">{{cite journal| author=DeLaPaz RL, Wippold FJ, Cornelius RS, Amin-Hanjani S, Angtuaco EJ, Broderick DF et al.| title=ACR Appropriateness Criteria® on cerebrovascular disease. | journal=J Am Coll Radiol | year= 2011 | volume= 8 | issue= 8 | pages= 532-8 | pmid=21807345 | doi=10.1016/j.jacr.2011.05.010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21807345  }}</ref>
+|style="background: #F5F5F5; padding: 5px;" |[[Confusion]], [[dizziness]], [[nausea]], [[vomiting]]
+|-
+|style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Neurosyphilis]]<ref name="pmid22482824">{{cite journal| author=Liu LL, Zheng WH, Tong ML, Liu GL, Zhang HL, Fu ZG et al.| title=Ischemic stroke as a primary symptom of neurosyphilis among HIV-negative emergency patients. | journal=J Neurol Sci | year= 2012 | volume= 317 | issue= 1-2 | pages= 35-9 | pmid=22482824 | doi=10.1016/j.jns.2012.03.003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22482824  }} </ref><ref name="pmid24365430">{{cite journal |vauthors=Berger JR, Dean D |title=Neurosyphilis |journal=Handb Clin Neurol |volume=121 |issue= |pages=1461–72 |year=2014 |pmid=24365430 |doi=10.1016/B978-0-7020-4088-7.00098-5 |url=}}</ref>
+|style="background: #F5F5F5; padding: 5px 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" |[[Sexually transmitted disease|STI]]<nowiki/>s
+|style="background: #F5F5F5; padding: 5px; text-align:center" | +
+|style="background: #F5F5F5; padding: 5px;" |'''↑''' [[Leukocytes]] and [[protein]]
+|style="background: #F5F5F5; padding: 5px;" |CSF [[VDRL]]-specifc
+CSF FTA-Ab -sensitive<ref name="pmid22421697">{{cite journal| author=Ho EL, Marra CM| title=Treponemal tests for neurosyphilis--less accurate than what we thought? | journal=Sex Transm Dis | year= 2012 | volume= 39 | issue= 4 | pages= 298-9 | pmid=22421697 | doi=10.1097/OLQ.0b013e31824ee574 | pmc=3746559 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22421697  }}</ref>
+|style="background: #F5F5F5; padding: 5px;" |[[Blindness]], [[confusion]], [[depression]],
+Abnormal [[gait]]
+|-
+|style="background: #DCDCDC; padding: 5px; text-align: center;" |Complex or atypical [[migraine]]
+|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" |Family history of [[migraine]]
+| style="background: #F5F5F5; padding: 5px;" | -
+| style="background: #F5F5F5; padding: 5px;" | -
+|style="background: #F5F5F5; padding: 5px;" |Clinical assesment
+|style="background: #F5F5F5; padding: 5px;" |Presence of aura, [[nausea]], [[vomiting]]
+|-
+|style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Hypertensive encephalopathy]]
+|style="background: #F5F5F5; padding: 5px 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" |[[Hypertension]]
+|style="background: #F5F5F5; padding: 5px;" | +
+|style="background: #F5F5F5; padding: 5px;" | -
+|style="background: #F5F5F5; padding: 5px;" |Clinical assesment
+|style="background: #F5F5F5; padding: 5px;" |[[Delirium]], [[cortical blindness]], [[cerebral edema]], [[seizure]]
+|-
+|style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Wernicke's encephalopathy|Wernicke’s encephalopathy]]
+|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" |History of alcohal abuse
+| style="background: #F5F5F5; padding: 5px;" | -
+| style="background: #F5F5F5; padding: 5px;" | -
+| style="background: #F5F5F5; padding: 5px;" |Clinical assesment and lab findings
+|style="background: #F5F5F5; padding: 5px;" |[[Ophthalmoplegia]], [[confusion]]
+|-
+|style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Brain abscess|CNS abscess]]
+|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" |History of [[drug abuse]], [[endocarditis]], [[immunosupression]]
+|style="background: #F5F5F5; padding: 5px;" | +
+|style="background: #F5F5F5; padding: 5px;" |'''↑''' leukocytes, '''↓''' glucose and '''↑''' protien
+|style="background: #F5F5F5; padding: 5px;" |MRI is more sensitive and specific
+|style="background: #F5F5F5; padding: 5px;" |High grade [[fever]], [[fatigue]],[[nausea]], [[vomiting]]
+|-
+|style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Drug toxicity]]
+|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;" |Drug screen test
+|style="background: #F5F5F5; padding: 5px;" |[[Lithium]], [[Sedatives]], [[phenytoin]], [[carbamazepine]]
+|-
+|style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Conversion disorder]]
+|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" |History of [[emotional stress]]
+| style="background: #F5F5F5; padding: 5px;" | -
+| style="background: #F5F5F5; padding: 5px;" | -
+|style="background: #F5F5F5; padding: 5px;" |Diagnosis of exclusion
+|style="background: #F5F5F5; padding: 5px;" |[[Tremor|Tremors]], [[blindness]], difficulty [[swallowing]]
+|-
+|style="background: #DCDCDC; padding: 5px; text-align: center;" |Metabolic disturbances ([[electrolyte imbalance]], [[hypoglycemia]])
+|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;" |[[Hypoglycemia]], [[Hyponatremia|hypo]] and [[hypernatremia]], [[Hypokalemia|hypo]] and [[hyperkalemia]]
+|style="background: #F5F5F5; padding: 5px;" |Depends on the cause
+| style="background: #F5F5F5; padding: 5px;" |[[Confusion]], [[seizure]], [[Palpitation|palpitations]], [[sweating]], [[dizziness]], [[hypoglycemia]]
+|-
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Meningitis]] or [[encephalitis]]
+|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" |History of [[fever]] and [[malaise]]
+| style="background: #F5F5F5; padding: 5px;" | -
+| style="background: #F5F5F5; padding: 5px; text-align:center" |'''↑''' Leukocytes,
+'''↑''' Protein
+↓ Glucose
+| style="background: #F5F5F5; padding: 5px;" |[[CSF analysis]]<ref name="pmid19398286">{{cite journal| author=Carbonnelle E| title=[Laboratory diagnosis of bacterial meningitis: usefulness of various tests for the determination of the etiological agent]. | journal=Med Mal Infect | year= 2009 | volume= 39 | issue= 7-8 | pages= 581-605 | pmid=19398286 | doi=10.1016/j.medmal.2009.02.017 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19398286  }}</ref>
+| style="background: #F5F5F5; padding: 5px;" |[[Fever]], [[Neck rigidity|neck]]
+[[Neck rigidity|rigidity]]
+|-
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Multiple sclerosis]] exacerbation
+|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" |History of relapses and remissions
+| style="background: #F5F5F5; padding: 5px; text-align:center" | +
+| style="background: #F5F5F5; padding: 5px; text-align:center" |'''↑'''  CSF IgG levels
+(monoclonal bands)
+| style="background: #F5F5F5; padding: 5px;" |Clinical assesment and [[MRI]] <ref name="pmid8274111">{{cite journal| author=Giang DW, Grow VM, Mooney C, Mushlin AI, Goodman AD, Mattson DH et al.| title=Clinical diagnosis of multiple sclerosis. The impact of magnetic resonance imaging and ancillary testing. Rochester-Toronto Magnetic Resonance Study Group. | journal=Arch Neurol | year= 1994 | volume= 51 | issue= 1 | pages= 61-6 | pmid=8274111 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8274111  }}</ref>
+| style="background: #F5F5F5; padding: 5px;" |[[Blurred vision|Blurry vision]], [[urinary incontinence]], [[fatigue]]
+|-
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Seizure]]
+|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" |Previous history of [[seizures]]
+| style="background: #F5F5F5; padding: 5px;" | -
+| style="background: #F5F5F5; padding: 5px;" |Mass lesion
+| style="background: #F5F5F5; padding: 5px;" |Clinical assesment and [[EEG]] <ref name="pmid11385043">{{cite journal| author=Manford M| title=Assessment and investigation of possible epileptic seizures. | journal=J Neurol Neurosurg Psychiatry | year= 2001 | volume= 70 Suppl 2 | issue=  | pages= II3-8 | pmid=11385043 | doi= | pmc=1765557 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11385043  }}</ref>
+| style="background: #F5F5F5; padding: 5px;" |[[Confusion]], [[apathy]], [[irritability]],
+|}
 ==Diagnosis==