Botulism differential diagnosis: Difference between revisions
Jump to navigation
Jump to search
Tarek Nafee (talk | contribs) |
Tarek Nafee (talk | contribs) |
||
Line 17: | Line 17: | ||
!<small>Motor Deficit</small> | !<small>Motor Deficit</small> | ||
!<small>Sensory deficit</small> | !<small>Sensory deficit</small> | ||
!<small>Cranial nerve</small> | !<small>Cranial nerve Involvement</small> | ||
!Autonomic dysfunction | !<small>Autonomic dysfunction</small> | ||
!Proximal/Distal/Generalized | !<small>Proximal/Distal/Generalized</small> | ||
!Ascending/Descending/Systemic | !<small>Ascending/Descending/Systemic</small> | ||
!<small>Unilateral (UL) | !<small>Unilateral (UL) | ||
or Bilateral (BL) | or Bilateral (BL) | ||
or | or | ||
No Lateralization (NL) | No Lateralization (NL)</small> | ||
!<small>Onset</small> | !<small>Onset</small> | ||
!Lab or Imaging Findings | !<small>Lab or Imaging Findings</small> | ||
!<small>Specific test</small> | !<small>Specific test</small> | ||
|- | |- | ||
Line 35: | Line 35: | ||
| 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" |<nowiki>+</nowiki> | ||
|Generalized | | style="background: #F5F5F5; padding: 5px text-align:center" |Generalized | ||
|Descending | | 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 | ||
Line 48: | Line 48: | ||
| 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" |<nowiki>+</nowiki> | ||
|Generalized | | style="background: #F5F5F5; padding: 5px text-align:center" |Generalized | ||
|Descending | | 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 | ||
Line 61: | Line 61: | ||
| 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" |<nowiki>-</nowiki> | ||
|Generalized | | style="background: #F5F5F5; padding: 5px text-align:center" |Generalized | ||
|Ascending | | style="background: #F5F5F5; padding: 5px text-align:center" |Ascending | ||
| style="background: #F5F5F5; padding: 5px text-align:center" |BL | | style="background: #F5F5F5; padding: 5px text-align:center" |BL | ||
| style="background: #F5F5F5; padding: 5px text-align:center" |Insidious | | style="background: #F5F5F5; padding: 5px text-align:center" |Insidious | ||
Line 77: | Line 77: | ||
| 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" |<nowiki>+</nowiki> | ||
|Generalized | | style="background: #F5F5F5; padding: 5px text-align:center" |Generalized | ||
|Systemic | | style="background: #F5F5F5; padding: 5px text-align:center" |Systemic | ||
| style="background: #F5F5F5; padding: 5px text-align:center" |BL | | style="background: #F5F5F5; padding: 5px text-align:center" |BL | ||
| style="background: #F5F5F5; padding: 5px text-align:center" |Intermittent | | style="background: #F5F5F5; padding: 5px text-align:center" |Intermittent | ||
Line 90: | Line 90: | ||
| 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" |<nowiki>+</nowiki> | ||
|Generalized | | style="background: #F5F5F5; padding: 5px text-align:center" |Generalized | ||
|Systemic | | style="background: #F5F5F5; padding: 5px text-align:center" |Systemic | ||
| style="background: #F5F5F5; padding: 5px text-align:center" |BL | | style="background: #F5F5F5; padding: 5px text-align:center" |BL | ||
| style="background: #F5F5F5; padding: 5px text-align:center" |Intermittent | | style="background: #F5F5F5; padding: 5px text-align:center" |Intermittent | ||
Line 103: | Line 103: | ||
| 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" |<nowiki>-</nowiki> | ||
|Generalized | | style="background: #F5F5F5; padding: 5px text-align:center" |Generalized | ||
|Systemic | | style="background: #F5F5F5; padding: 5px text-align:center" |Systemic | ||
| style="background: #F5F5F5; padding: 5px text-align:center" |BL | | style="background: #F5F5F5; padding: 5px text-align:center" |BL | ||
| style="background: #F5F5F5; padding: 5px text-align:center" |Insidious | | style="background: #F5F5F5; padding: 5px text-align:center" |Insidious | ||
Line 116: | Line 116: | ||
| 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" |<nowiki>+</nowiki> | ||
|Generalized | | style="background: #F5F5F5; padding: 5px text-align:center" |Generalized | ||
|Ascending | | style="background: #F5F5F5; padding: 5px text-align:center" |Ascending | ||
| style="background: #F5F5F5; padding: 5px text-align:center" |BL | | style="background: #F5F5F5; padding: 5px text-align:center" |BL | ||
| style="background: #F5F5F5; padding: 5px text-align:center" |Sudden | | style="background: #F5F5F5; padding: 5px text-align:center" |Sudden | ||
Line 129: | Line 129: | ||
| 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" |<nowiki>-</nowiki> | ||
|Generalized | | style="background: #F5F5F5; padding: 5px text-align:center" |Generalized | ||
|Ascending | | style="background: #F5F5F5; padding: 5px text-align:center" |Ascending | ||
| style="background: #F5F5F5; padding: 5px text-align:center" |BL | | style="background: #F5F5F5; padding: 5px text-align:center" |BL | ||
| style="background: #F5F5F5; padding: 5px text-align:center" |Insidious | | style="background: #F5F5F5; padding: 5px text-align:center" |Insidious | ||
Line 142: | Line 142: | ||
| 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" |<nowiki>+</nowiki> | ||
|Generalized | | style="background: #F5F5F5; padding: 5px text-align:center" |Generalized | ||
|Systemic | | style="background: #F5F5F5; padding: 5px text-align:center" |Systemic | ||
| style="background: #F5F5F5; padding: 5px text-align:center" |BL | | style="background: #F5F5F5; padding: 5px text-align:center" |BL | ||
| style="background: #F5F5F5; padding: 5px text-align:center" |Sudden | | style="background: #F5F5F5; padding: 5px text-align:center" |Sudden | ||
Line 155: | Line 155: | ||
| 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" |<nowiki>+/-</nowiki> | ||
|Generalized | | style="background: #F5F5F5; padding: 5px text-align:center" |Generalized | ||
|Systemic | | style="background: #F5F5F5; padding: 5px text-align:center" |Systemic | ||
| style="background: #F5F5F5; padding: 5px text-align:center" |UL | | style="background: #F5F5F5; padding: 5px text-align:center" |UL | ||
| style="background: #F5F5F5; padding: 5px text-align:center" |Sudden | | style="background: #F5F5F5; padding: 5px text-align:center" |Sudden | ||
Line 168: | Line 168: | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" |+ | | style="background: #F5F5F5; padding: 5px; text-align:center" |+ | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" |+ | | style="background: #F5F5F5; padding: 5px; text-align:center" |+ | ||
| | | style="background: #F5F5F5; padding: 5px text-align:center" | | ||
|Proximal > Distal | | style="background: #F5F5F5; padding: 5px text-align:center" |Proximal > Distal | ||
|Systemic | | style="background: #F5F5F5; padding: 5px text-align:center" |Systemic | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" |BL or UL | | style="background: #F5F5F5; padding: 5px; text-align:center" |BL or UL | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" |Sudden | | style="background: #F5F5F5; padding: 5px; text-align:center" |Sudden | ||
Line 181: | Line 181: | ||
| 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" |<nowiki>+</nowiki> | ||
|Proximal > Distal | | style="background: #F5F5F5; padding: 5px text-align:center" |Proximal > Distal | ||
|Systemic | | style="background: #F5F5F5; padding: 5px text-align:center" |Systemic | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" |BL or UL | | style="background: #F5F5F5; padding: 5px; text-align:center" |BL or UL | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" |Sudden | | style="background: #F5F5F5; padding: 5px; text-align:center" |Sudden | ||
Line 194: | Line 194: | ||
| style="background: #F5F5F5; padding: 5px text-align:center" | + | | style="background: #F5F5F5; padding: 5px text-align:center" | + | ||
| style="background: #F5F5F5; padding: 5px text-align:center" | - | | style="background: #F5F5F5; padding: 5px text-align:center" | - | ||
| | | style="background: #F5F5F5; padding: 5px text-align:center" | | ||
|Generalized | | style="background: #F5F5F5; padding: 5px text-align:center" |Generalized | ||
|Systemic | | style="background: #F5F5F5; padding: 5px text-align:center" |Systemic | ||
| style="background: #F5F5F5; padding: 5px text-align:center" |BL | | style="background: #F5F5F5; padding: 5px text-align:center" |BL | ||
| style="background: #F5F5F5; padding: 5px text-align:center" |Insidious<nowiki/> | | style="background: #F5F5F5; padding: 5px text-align:center" |Insidious<nowiki/> | ||
Line 208: | Line 208: | ||
| 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" |<nowiki>-</nowiki> | ||
|Proximal > Distal | | style="background: #F5F5F5; padding: 5px text-align:center" |Proximal > Distal | ||
|Systemic | | style="background: #F5F5F5; padding: 5px text-align:center" |Systemic | ||
| style="background: #F5F5F5; padding: 5px text-align:center" |BL | | style="background: #F5F5F5; padding: 5px text-align:center" |BL | ||
| style="background: #F5F5F5; padding: 5px text-align:center" |Insidious | | style="background: #F5F5F5; padding: 5px text-align:center" |Insidious | ||
Line 221: | Line 221: | ||
| 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" |<nowiki>+</nowiki> | ||
|Generalized | | style="background: #F5F5F5; padding: 5px text-align:center" |Generalized | ||
|Systemic | | style="background: #F5F5F5; padding: 5px text-align:center" |Systemic | ||
| style="background: #F5F5F5; padding: 5px text-align:center" |NL | | style="background: #F5F5F5; padding: 5px text-align:center" |NL | ||
| style="background: #F5F5F5; padding: 5px text-align:center" |Sudden | | style="background: #F5F5F5; padding: 5px text-align:center" |Sudden | ||
Line 235: | Line 235: | ||
| 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" |<nowiki>-</nowiki> | ||
|Generalized | | style="background: #F5F5F5; padding: 5px text-align:center" |Generalized | ||
|Systemic | | style="background: #F5F5F5; padding: 5px text-align:center" |Systemic | ||
| style="background: #F5F5F5; padding: 5px text-align:center" |BL | | style="background: #F5F5F5; padding: 5px text-align:center" |BL | ||
| style="background: #F5F5F5; padding: 5px text-align:center" |Insidious | | style="background: #F5F5F5; padding: 5px text-align:center" |Insidious | ||
Line 248: | Line 248: | ||
| 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" |<nowiki>-</nowiki> | ||
|Proximal > Distal | | style="background: #F5F5F5; padding: 5px text-align:center" |Proximal > Distal | ||
|Systemic | | style="background: #F5F5F5; padding: 5px text-align:center" |Systemic | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" |UL or BL | | style="background: #F5F5F5; padding: 5px; text-align:center" |UL or BL | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" |Insidious | | style="background: #F5F5F5; padding: 5px; text-align:center" |Insidious |
Revision as of 21:25, 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.