Botulism differential diagnosis: Difference between revisions
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|- style="background: #4479BA; color: #FFFFFF; text-align: center;" | |- style="background: #4479BA; color: #FFFFFF; text-align: center;" | ||
! rowspan="2" |<small>Diseases</small> | ! rowspan="2" |<small>Diseases</small> | ||
! colspan=" | ! colspan="8" |<small>History and Physical | ||
! colspan="2" |<small>Diagnostic tests</small> | ! colspan="2" |<small>Diagnostic tests</small> | ||
! rowspan="2" |<small>Other Findings</small> | ! rowspan="2" |<small>Other Findings</small> | ||
|- style="background: #4479BA; color: #FFFFFF; text-align: center;" | |- style="background: #4479BA; color: #FFFFFF; text-align: center;" | ||
!<small>Motor Deficit</small> | !<small>Motor Deficit</small> | ||
!<small>Sensory deficit</small> | !<small>Sensory deficit</small> | ||
Line 22: | Line 20: | ||
!Autonomic dysfunction | !Autonomic dysfunction | ||
!Proximal/Distal/Generalized | !Proximal/Distal/Generalized | ||
!Ascending/Descending/ | !Ascending/Descending/Systemic | ||
!<small>Unilateral (UL) | !<small>Unilateral (UL) | ||
or Bilateral (BL) </small> | or Bilateral (BL) </small> | ||
or | |||
No Lateralization (NL) | |||
!<small>Onset</small> | !<small>Onset</small> | ||
!Lab or Imaging Findings | !Lab or Imaging Findings | ||
Line 30: | Line 32: | ||
|- | |- | ||
| style="background: #DCDCDC; padding: 5px; text-align: center;" | Adult Botulism | | 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" | + | | style="background: #F5F5F5; padding: 5px text-align:center" | + | ||
| | |<nowiki>+</nowiki> | ||
| | |Generalized | ||
|Descending | |Descending | ||
| style="background: #F5F5F5; padding: 5px text-align:center" |BL | | 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" |Sudden | ||
| style="background: #F5F5F5; padding: 5px text-align:center" | | | style="background: #F5F5F5; padding: 5px text-align:center" |Toxin test | ||
| style="background: #F5F5F5; padding: 5px;" |Blood, Wound, or Stool culture | | style="background: #F5F5F5; padding: 5px;" |Blood, Wound, or Stool culture | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
|- | |- | ||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Infant Botulism | | 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> | |||
|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" |BL | ||
| style="background: #F5F5F5; padding: 5px text-align:center" |Sudden | | 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" |Toxin test | ||
| style="background: #F5F5F5; padding: 5px text-align:center" |Blood, Wound, or Stool culture | | style="background: #F5F5F5; padding: 5px text-align:center" |Blood, Wound, or Stool culture | ||
| style="background: #F5F5F5; padding: 5px text-align:center" | | | style="background: #F5F5F5; padding: 5px text-align:center" | | ||
|- | |- | ||
| style="background: #DCDCDC; padding: 5px; text-align: center;" | [[Guillian-Barre syndrome]] | | style="background: #DCDCDC; padding: 5px; text-align: center;" | [[Guillian-Barre syndrome]] | ||
| 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" | - | ||
| - | |<nowiki>-</nowiki> | ||
| | |Generalized | ||
|Ascending | |||
| | |||
| style="background: #F5F5F5; padding: 5px text-align:center" |BL | | 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" |Insidious | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |CSF: ↑Protein | ||
| style="background: #F5F5F5; padding: 5px;" | | |||
↓Cells | |||
| style="background: #F5F5F5; padding: 5px;" |Clinical & Lumbar Puncture | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
|- | |- | ||
| style="background: #DCDCDC; padding: 5px; text-align: center;" | [[Eaton lambert syndrome|Eaton Lambert syndrome]] | | style="background: #DCDCDC; padding: 5px; text-align: center;" | [[Eaton lambert syndrome|Eaton Lambert syndrome]] | ||
| 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" | + | ||
| | |<nowiki>+</nowiki> | ||
|Generalized | |||
|Systemic | |||
| | |||
| | |||
| style="background: #F5F5F5; padding: 5px text-align:center" |BL | | 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" |Intermittent | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |AB | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
|- | |- | ||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Myasthenia gravis]] | | style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Myasthenia gravis]] | ||
| 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" | + | ||
| | |<nowiki>+</nowiki> | ||
| | |Generalized | ||
|Systemic | |||
| | |||
| style="background: #F5F5F5; padding: 5px text-align:center" |BL | | 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" |Intermittent | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |Ach receptor antibody | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
|- | |- | ||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Electrolyte disturbance]] | | style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Electrolyte disturbance]] | ||
| 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" | - | ||
| | |<nowiki>-</nowiki> | ||
| | |Generalized | ||
| | |Systemic | ||
| style="background: #F5F5F5; padding: 5px text-align:center" |BL | | 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" |Insidious | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | Electrolyte panel | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |↓Ca++, ↓Mg++, ↓K+ | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
|- | |- | ||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Organophosphate poisoning|Organophosphate toxicity]] | | style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Organophosphate poisoning|Organophosphate 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" | - | ||
| | |<nowiki>+</nowiki> | ||
| | |Generalized | ||
| | |Ascending | ||
| style="background: #F5F5F5; padding: 5px text-align:center" |BL | | 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" |Sudden | ||
Line 150: | Line 126: | ||
|- | |- | ||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Tick paralysis]] ([[Dermacentor andersoni|Dermacentor tick]]) | | style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Tick paralysis]] ([[Dermacentor andersoni|Dermacentor tick]]) | ||
| 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" | - | ||
| | |<nowiki>-</nowiki> | ||
| | |Generalized | ||
| | |Ascending | ||
| style="background: #F5F5F5; padding: 5px text-align:center" |BL | | 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" |Insidious | ||
Line 165: | Line 139: | ||
|- | |- | ||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Tetrodotoxin]] poisoning | | style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Tetrodotoxin]] poisoning | ||
| 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" | + | ||
| | |<nowiki>+</nowiki> | ||
|Generalized | |||
| | |Systemic | ||
| | |||
| style="background: #F5F5F5; padding: 5px text-align:center" |BL | | 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" |Sudden | ||
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| 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" | +/- | ||
| style="background: #F5F5F5; padding: 5px text-align:center" | + | |<nowiki>+/-</nowiki> | ||
| | |Generalized | ||
|Systemic | |||
| | |||
| | |||
| style="background: #F5F5F5; padding: 5px text-align:center" |UL | | 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" |Sudden | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | MRI +ve for ischemia or hemorrhage | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |MRI | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
|- | |- | ||
| style="background: #DCDCDC; padding: 5px; text-align:center;" | [[Poliomyelitis]] | | style="background: #DCDCDC; padding: 5px; text-align:center;" | [[Poliomyelitis]] | ||
| 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" | | |||
| | | | ||
| | |Proximal > Distal | ||
| | |Systemic | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" | | | 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" |Sudden | ||
| 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" |PCR of CSF | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" | | | style="background: #F5F5F5; padding: 5px; text-align:center" | | ||
|- | |- | ||
| style="background: #DCDCDC; padding: 5px; text-align:center;" | [[Transverse myelitis]] | | style="background: #DCDCDC; padding: 5px; text-align:center;" | [[Transverse myelitis]] | ||
| 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" | | |<nowiki>+</nowiki> | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" | | |Proximal > Distal | ||
| | |Systemic | ||
| | | style="background: #F5F5F5; padding: 5px; text-align:center" |BL or UL | ||
| | |||
| style="background: #F5F5F5; padding: 5px; text-align:center" | | |||
| style="background: #F5F5F5; padding: 5px; text-align:center" |Sudden | | 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" |MRI & Lumbar puncture | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" | | | style="background: #F5F5F5; padding: 5px; text-align:center" |MRI | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" | | | style="background: #F5F5F5; padding: 5px; text-align:center" | | ||
|- | |- | ||
| 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;" |[[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" | - | ||
| | | | ||
| | |Generalized | ||
| | |Systemic | ||
| style="background: #F5F5F5; padding: 5px text-align:center" |BL | | 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" |Insidious<nowiki/> | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |MRI & Lumbar puncture | ||
| style="background: #F5F5F5; padding: 5px;" |CSF [[VDRL]]-specifc | | 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> | 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> | ||
Line 241: | Line 205: | ||
|- | |- | ||
| style="background: #DCDCDC; padding: 5px; text-align:center;" |[[Muscular dystrophy]] | | style="background: #DCDCDC; padding: 5px; text-align:center;" |[[Muscular dystrophy]] | ||
| 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" | - | ||
| | |<nowiki>-</nowiki> | ||
|Proximal | |Proximal > Distal | ||
| | |Systemic | ||
| style="background: #F5F5F5; padding: 5px text-align:center" | | | 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" |Insidious | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | Genetic testing | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |Muscle biopsy | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
|- | |- | ||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Multiple sclerosis]] exacerbation | | 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" | + | ||
| | |<nowiki>+</nowiki> | ||
| | |Generalized | ||
| style="background: #F5F5F5; padding: 5px text-align:center" | | |Systemic | ||
| style="background: #F5F5F5; padding: 5px text-align:center" | | | 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 IgG levels | | style="background: #F5F5F5; padding: 5px; text-align:center" |'''↑'''CSF IgG levels | ||
(monoclonal bands) | (monoclonal bands) | ||
Line 272: | Line 232: | ||
|- | |- | ||
| style="background: #DCDCDC; padding: 5px; text-align:center;" |[[Amyotrophic lateral sclerosis]] | | style="background: #DCDCDC; padding: 5px; text-align:center;" |[[Amyotrophic lateral sclerosis]] | ||
| 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" | - | ||
| | |<nowiki>-</nowiki> | ||
| | |Generalized | ||
| | |Systemic | ||
| style="background: #F5F5F5; padding: 5px text-align:center" | | | 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" |Insidious | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | Normal LP (to rule out DDx) | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |MRI & LP | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
|- | |- | ||
| style="background: #DCDCDC; padding: 5px; text-align:center;" | [[Myositis]] | | style="background: #DCDCDC; padding: 5px; text-align:center;" | [[Myositis]] | ||
| 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" | | |<nowiki>-</nowiki> | ||
|Proximal > Distal | |||
| | |Systemic | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" |UL or BL | |||
|Proximal | |||
| | |||
| style="background: #F5F5F5; padding: 5px; text-align:center" | | |||
| style="background: #F5F5F5; padding: 5px; text-align:center" |Insidious | | style="background: #F5F5F5; padding: 5px; text-align:center" |Insidious | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" | | | style="background: #F5F5F5; padding: 5px; text-align:center" |Elevated CK & Aldolase | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" |Muscle biopsy | | style="background: #F5F5F5; padding: 5px; text-align:center" |Muscle biopsy | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" | | | style="background: #F5F5F5; padding: 5px; text-align:center" | |
Revision as of 19:17, 22 May 2017
Botulism Microchapters |
Diagnosis |
---|
Treatment |
Case Studies |
Botulism differential diagnosis On the Web |
American Roentgen Ray Society Images of Botulism differential diagnosis |
Risk calculators and risk factors for Botulism differential diagnosis |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Michael Maddaleni, B.S.
Overview
Botulism must be differentiated from neuromuscular disorders that present with muscle weakness and flaccidity.
Differentiating Botulism from other Diseases
Botulism must be differentiated from neuromuscular disorders that present with muscle weakness and flaccidity, such as:
Diseases | History and Physical | Diagnostic tests | Other Findings | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
Motor Deficit | Sensory deficit | Cranial nerve Involvement | Autonomic dysfunction | Proximal/Distal/Generalized | Ascending/Descending/Systemic | Unilateral (UL)
or Bilateral (BL) or No Lateralization (NL) |
Onset | Lab or Imaging Findings | Specific test | ||
Adult Botulism | + | - | + | + | Generalized | Descending | BL | Sudden | Toxin test | Blood, Wound, or Stool culture | |
Infant Botulism | + | - | + | + | Generalized | Descending | BL | Sudden | Toxin test | Blood, Wound, or Stool culture | |
Guillian-Barre syndrome | + | - | - | - | Generalized | Ascending | BL | Insidious | CSF: ↑Protein
↓Cells |
Clinical & Lumbar Puncture | |
Eaton Lambert syndrome | + | - | + | + | Generalized | Systemic | BL | Intermittent | AB | ||
Myasthenia gravis | + | - | + | + | Generalized | Systemic | BL | Intermittent | Ach receptor antibody | ||
Electrolyte disturbance | + | + | - | - | Generalized | Systemic | BL | Insidious | Electrolyte panel | ↓Ca++, ↓Mg++, ↓K+ | |
Organophosphate toxicity | + | + | - | + | Generalized | Ascending | BL | Sudden | |||
Tick paralysis (Dermacentor tick) | + | - | - | - | Generalized | Ascending | BL | Insidious | |||
Tetrodotoxin poisoning | + | - | + | + | Generalized | Systemic | BL | Sudden | |||
Stroke | +/- | +/- | +/- | +/- | Generalized | Systemic | UL | Sudden | MRI +ve for ischemia or hemorrhage | MRI | |
Poliomyelitis | + | + | + | Proximal > Distal | Systemic | BL or UL | Sudden | PCR of CSF | |||
Transverse myelitis | + | + | + | + | Proximal > Distal | Systemic | BL or UL | Sudden | MRI & Lumbar puncture | MRI | |
Neurosyphilis[1][2] | + | + | - | Generalized | Systemic | BL | Insidious | MRI & Lumbar puncture | CSF VDRL-specifc
CSF FTA-Ab -sensitive[3] |
||
Muscular dystrophy | + | - | - | - | Proximal > Distal | Systemic | BL | Insidious | Genetic testing | Muscle biopsy | |
Multiple sclerosis exacerbation | + | + | + | + | Generalized | Systemic | NL | Sudden | ↑CSF IgG levels
(monoclonal bands) |
Clinical assesment and MRI [4] | Blurry vision, urinary incontinence, fatigue |
Amyotrophic lateral sclerosis | + | - | - | - | Generalized | Systemic | BL | Insidious | Normal LP (to rule out DDx) | MRI & LP | |
Myositis | + | - | - | - | Proximal > Distal | Systemic | UL or BL | Insidious | Elevated CK & Aldolase | Muscle biopsy |
References
- ↑ 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.
- ↑ 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.