Tetanus differential diagnosis: Difference between revisions

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  | pmid = 12151848
  | pmid = 12151848
}}</ref>
}}</ref>
   
   
   
*Tetanus associated [[trismus]]
*Tetanus associated [[trismus]]
*[[Temporomandibular joint]] ([[TMJ]]) dysfunction
*[[Temporomandibular joint]] ([[TMJ]]) dysfunction
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{| style="border: 2px solid #DCDCDC; font-size: 90%; width: 83%;"
{| style="border: 2px solid #DCDCDC; font-size: 90%; width: 83%;"
|+ '''Differential Diagnosis of Tetanus'''
|+ '''Differential Diagnosis on the basis of Rigidity and Fever'''
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Disease
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Disease
! colspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Diagnosis
! colspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Diagnosis
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! align="center" style="background:#4479BA; color: #FFFFFF;" |Laboratory Findings
! align="center" style="background:#4479BA; color: #FFFFFF;" |Laboratory Findings
|-
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | [[Tetanus]]  
| style="background: #F5F5F5; padding: 5px; text-align: center;" | [[Tetanus]]<ref name="pmid27538652">{{cite journal| author=Woldeamanuel YW, Andemeskel AT, Kyei K, Woldeamanuel MW, Woldeamanuel W| title=Case fatality of adult tetanus in Africa: Systematic review and meta-analysis. | journal=J Neurol Sci | year= 2016 | volume= 368 | issue=  | pages= 292-9 | pmid=27538652 | doi=10.1016/j.jns.2016.07.025 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27538652  }} </ref><ref name="pmid26598719">{{cite journal| author=Thwaites CL, Loan HT| title=Eradication of tetanus. | journal=Br Med Bull | year= 2015 | volume= 116 | issue=  | pages= 69-77 | pmid=26598719 | doi=10.1093/bmb/ldv044 | pmc=4674006 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26598719  }} </ref>
| style="background: #DCDCDC; padding: 5px;" |
| style="background: #DCDCDC; padding: 5px;" |
*Tonic contraction of muscles between the spasmodic episodes
*Tonic contraction of muscles between the spasmodic episodes
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* Human TIG
* Human TIG
|-
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | [[Neuroleptic malignant syndrome|Neuroleptic Malignant Syndrome]]  
| style="background: #F5F5F5; padding: 5px; text-align: center;" | [[Neuroleptic malignant syndrome|Neuroleptic Malignant Syndrome]] <ref name="pmid28533580">{{cite journal| author=Hosseini S, Elyasi F| title=Olanzapine-Induced Neuroleptic Malignant Syndrome. | journal=Iran J Med Sci | year= 2017 | volume= 42 | issue= 3 | pages= 306-309 | pmid=28533580 | doi= | pmc=5429500 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28533580  }} </ref><ref name="pmid28488314">{{cite journal| author=Leenhardt F, Perier D, Pinzani V, Giraud I, Villiet M, Castet-Nicolas A et al.| title=Pharmacist intervention to detect drug adverse events on admission to the emergency department: Two case reports of neuroleptic malignant syndrome. | journal=J Clin Pharm Ther | year= 2017 | volume=  | issue=  | pages=  | pmid=28488314 | doi=10.1111/jcpt.12531 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28488314  }} </ref>
| style="background: #DCDCDC; padding: 5px;" |
| style="background: #DCDCDC; padding: 5px;" |
*History of intake of offending drugs e.g [[neuroleptics]] like:
*History of intake of offending drugs e.g [[neuroleptics]] like:
**[[Fluphenazine]]  
**[[Fluphenazine]]  
**[[Haloperidol]]
**[[Haloperidol]]
**[[Olanzapine]]
**[[Risperidone]]
**[[Risperidone]]
*[[Autonomic instability]]
*[[Autonomic instability]]
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* [[Agitation]]
* [[Agitation]]
| style="background: #DCDCDC; padding: 5px;" |
| style="background: #DCDCDC; padding: 5px;" |
* [[Myoglobinemia]]
** [[Myoglobinemia]]
* Elevated [[LDH]]
** Elevated [[LDH]]
* Elevated [[creatine kinase]]  
** Elevated [[creatine kinase]]  
* [[Hyperkalemia]]
** [[Hyperkalemia]]
* Elevated [[AST]] and [[ALT]]
** Elevated [[AST]] and [[ALT]]
* [[Hyperphosphatemia]]
** [[Hyperphosphatemia]]
* Elevated [[alkaline phosphatase]]
** Elevated [[alkaline phosphatase]]
* [[Hyperuricemia]]
** [[Hyperuricemia]]
| style="background: #DCDCDC; padding: 5px;" |
| style="background: #DCDCDC; padding: 5px;" |
* Supportive therapy
* Supportive therapy
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** [[Bromocriptine]]
** [[Bromocriptine]]
|-
|-
| style="background: #F5F5F5; padding: 5px;" | [[Meningitis|Viral Meningitis]]<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>
| style="background: #F5F5F5; padding: 5px;" | [[Meningitis|Viral Meningitis]]<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="pmid15319091">{{cite journal| author=Tyler KL| title=Herpes simplex virus infections of the central nervous system: encephalitis and meningitis, including Mollaret's. | journal=Herpes | year= 2004 | volume= 11 Suppl 2 | issue=  | pages= 57A-64A | pmid=15319091 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15319091 }} </ref>
| style="background: #DCDCDC; padding: 5px;" |
| style="background: #DCDCDC; padding: 5px;" |
* [[Fever]]
* [[Fever]]
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** [[Acetaminophen]] for [[fever]].
** [[Acetaminophen]] for [[fever]].
* Anti-viral therapy:
* Anti-viral therapy:
** [[Acyclovir]] <sup>[[Viral meningitis medical therapy#cite note-pmid15319091-2|[2]]]</sup>
** [[Acyclovir]]
** [[Pleconaril]]
** [[Pleconaril]]
|-
|-
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* [[Prednisone]], [[plasmapheresis]], [[IVIG]] ( some success)
* [[Prednisone]], [[plasmapheresis]], [[IVIG]] ( some success)
|-
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | [[Drug]] induced  [[Tardive dyskinesia|(Tardive dyskinesia]])
| style="background: #F5F5F5; padding: 5px; text-align: center;" | [[Drug]] induced  [[Tardive dyskinesia|(Tardive dyskinesia]])<ref name="pmid28552340">{{cite journal| author=Deng ZD, Li DY, Zhang CC, Pan YX, Zhang J, Jin H et al.| title=Long-term follow-up of bilateral subthalamic deep brain stimulation for refractory tardive dystonia. | journal=Parkinsonism Relat Disord | year= 2017 | volume=  | issue=  | pages=  | pmid=28552340 | doi=10.1016/j.parkreldis.2017.05.010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28552340  }} </ref><ref name="pmid28520698">{{cite journal| author=| title=Valbenazine (Ingrezza) for tardive dyskinesia. | journal=Med Lett Drugs Ther | year= 2017 | volume= 59 | issue= 1521 | pages= 83-84 | pmid=28520698 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28520698  }} </ref><ref name="pmid28510661">{{cite journal| author=Voelker R| title=Tardive Dyskinesia Drug Approved. | journal=JAMA | year= 2017 | volume= 317 | issue= 19 | pages= 1942 | pmid=28510661 | doi=10.1001/jama.2017.5537 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28510661  }} </ref>
| style="background: #DCDCDC; padding: 5px;" |  
| style="background: #DCDCDC; padding: 5px;" |  
*History of intake of the offending drug for at least one month
*History of intake of the offending drug for at least one month
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**''Strychnos nux vomica seeds''
**''Strychnos nux vomica seeds''
**Rodenticide
**Rodenticide
| style="background: #F5F5F5; padding: 5px; text-align: center;" |  
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
* Hypervigilance
* Anxiety
* Mydriasis
* Hypereflexia
* Clonus
* Facial and neck stiffness
| style="background: #DCDCDC; padding: 5px;" |
| style="background: #DCDCDC; padding: 5px;" |
* Blood assay
* Blood assay
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* Urine assay
* Urine assay
| style="background: #DCDCDC; padding: 5px;" |
| style="background: #DCDCDC; padding: 5px;" |
* Initial stabilization
* High dose [[Benzodiazepines]]
* Intubation and airway securing
|-
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | [[Hypocalcaemia]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" | [[Hypocalcaemia]]<ref name="pmid27065735">{{cite journal| author=Chhabra P, Rana SS, Sharma V, Sharma R, Bhasin DK| title=Hypocalcemic tetany: a simple bedside marker of poor outcome in acute pancreatitis. | journal=Ann Gastroenterol | year= 2016 | volume= 29 | issue= 2 | pages= 214-20 | pmid=27065735 | doi=10.20524/aog.2016.0015 | pmc=4805743 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27065735  }} </ref><ref name="pmid24171002">{{cite journal| author=Desai M, Kolla PK, Reddy PL| title=Calcium unresponsive hypocalcemic tetany: gitelman syndrome with hypocalcemia. | journal=Case Rep Med | year= 2013 | volume= 2013 | issue=  | pages= 197374 | pmid=24171002 | doi=10.1155/2013/197374 | pmc=3792521 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24171002  }} </ref>
| style="background: #DCDCDC; padding: 5px;" |
| style="background: #DCDCDC; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px; text-align: center;" |  
**[[Muscle]] [[twitching]] and [[cramping]]
**Circumoral and extremity [[paresthesia]] or [[tingling]]
** [[Altered mental status]]
** [[Irritability]]
** [[Depression]]
** [[Psychosis]]
** [[Seizure]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
** [[Tetany (medical sign)|Tetany]] (carpopedal spasm)
** Latent tetany
*** [[Trousseau sign of latent tetany]] 
*** [[Chvostek's sign]] 
** Hyperactive tendon reflexes
| style="background: #DCDCDC; padding: 5px;" |
| style="background: #DCDCDC; padding: 5px;" |
* Decreased blood [[calcium]] levels
| style="background: #DCDCDC; padding: 5px;" |
| style="background: #DCDCDC; padding: 5px;" |
* Two [[Ampule|ampules]] of [[intravenous]] [[calcium gluconate]] 10% is given slowly in a period of 10 minutes, or
* If hypocalcemia is severe, [[calcium chloride]] is given instead
* Maintenance doses of both calcium and [[vitamin-D]]
|-
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | [[Dental abscess]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" | [[Dental abscess]]<ref name="pmid28317564">{{cite journal| author=Ogle OE| title=Odontogenic Infections. | journal=Dent Clin North Am | year= 2017 | volume= 61 | issue= 2 | pages= 235-252 | pmid=28317564 | doi=10.1016/j.cden.2016.11.004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28317564  }} </ref><ref name="pmid27930461">{{cite journal| author=Bertossi D, Barone A, Iurlaro A, Marconcini S, De Santis D, Finotti M et al.| title=Odontogenic Orofacial Infections. | journal=J Craniofac Surg | year= 2017 | volume= 28 | issue= 1 | pages= 197-202 | pmid=27930461 | doi=10.1097/SCS.0000000000003250 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27930461  }} </ref>
| style="background: #DCDCDC; padding: 5px;" |
| style="background: #DCDCDC; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px; text-align: center;" |  
* Tooth pain
* Painful eating and chewing
* [[Fever]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
* Poor oral hygiene
* Presence of a dental infection
* Swollen gums
* No progression of spasm with time
* Cheek swelling
| style="background: #DCDCDC; padding: 5px;" |
| style="background: #DCDCDC; padding: 5px;" |
* Clinical diagnosis
* Labs may include
** Microscopic exam of stained smear
** Culture of oral swab
** Blood culture
| style="background: #DCDCDC; padding: 5px;" |
| style="background: #DCDCDC; padding: 5px;" |
* Improved dental hygiene
** Use of fluoridated water
** Brushing regularly
* [[Antibiotics]]
* Dental extraction in case of severity
|-
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | [[Parkinson's disease]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" | [[Parkinson's disease]]<ref name="pmid11402154">{{cite journal| author=Olanow CW, Watts RL, Koller WC| title=An algorithm (decision tree) for the management of Parkinson's disease (2001): treatment guidelines. | journal=Neurology | year= 2001 | volume= 56 | issue= 11 Suppl 5 | pages= S1-S88 | pmid=11402154 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11402154  }} </ref><ref name="pmid24756517">{{cite journal| author=Connolly BS, Lang AE| title=Pharmacological treatment of Parkinson disease: a review. | journal=JAMA | year= 2014 | volume= 311 | issue= 16 | pages= 1670-83 | pmid=24756517 | doi=10.1001/jama.2014.3654 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24756517  }} </ref>
| style="background: #DCDCDC; padding: 5px;" |
| style="background: #DCDCDC; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px; text-align: center;" |  
* [[Stiffness]]
* Inability to write
* Jerky movements at rest
* [[Constipation]]
* Sleeping difficulty
* Walking difficulty
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
* [[Tremor]]
* Rigidity
* [[Bradykinesia]]
* [[Postural instability]]
* Shuffling gait
| style="background: #DCDCDC; padding: 5px;" |
| style="background: #DCDCDC; padding: 5px;" |
* Clinical diagnosis
* Improvement with dopaminergic therapy confirms diagnosis
| style="background: #DCDCDC; padding: 5px;" |
| style="background: #DCDCDC; padding: 5px;" |
* Symptomatic therapy
* [[Dopamine agonists]]
* [[Levodopa]]
* [[Amantadine]]
* [[MAO inhibitors]]
* COMT inhibitors
* [[Anticholinergics]]
|}
|}


Revision as of 21:04, 12 June 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Michael Maddaleni, B.S.; Associate Editor(s)-in-Chief: Usama Talib, BSc, MD [2]

Overview

Tetanus must be differentiated from strychnine poisoning, dental infections, drug reactions, hypocalcemia, meningitis, stroke and stiff man syndrome.[1]

Differentiating Tetanus from other Diseases

Some of the other diseases that need to be considered when trying to diagnose tetanus include:[2][3][4]

Differential for Unilateral Involuntary Face Movements

The differential diagnosis for abnormal one sided movements of the face includes:[5][6][7][8][9][10][11][12][13][14][15]

Differential Diagnosis on the basis of Rigidity and Fever
Disease Diagnosis Treatment
Symptoms Signs Laboratory Findings
Tetanus[16][17]
  • Not significant
Neuroleptic Malignant Syndrome [18][19]
Viral Meningitis[20][21][22]
Stiff man syndrome
  • Marked rigidity
  • Spasms
    • Intermittent
    • Painful
    • Absent during sleep
Drug induced (Tardive dyskinesia)[23][24][25]
  • History of intake of the offending drug for at least one month
  • Eye deviation
  • Head and neck jerky movements
  • No tonic contraction of the muscles between the spasms
Strychnine poisoning[26][27][28][29]
  • Hx of up to date tetanus immunizations
  • History of intentional or accidental intake
    • Strychnos nux vomica seeds
    • Rodenticide
  • Hypervigilance
  • Anxiety
  • Mydriasis
  • Hypereflexia
  • Clonus
  • Facial and neck stiffness
  • Blood assay
  • Tissue assay
  • Urine assay
  • Initial stabilization
  • High dose Benzodiazepines
  • Intubation and airway securing
Hypocalcaemia[30][31]
Dental abscess[32][33]
  • Tooth pain
  • Painful eating and chewing
  • Fever
  • Poor oral hygiene
  • Presence of a dental infection
  • Swollen gums
  • No progression of spasm with time
  • Cheek swelling
  • Clinical diagnosis
  • Labs may include
    • Microscopic exam of stained smear
    • Culture of oral swab
    • Blood culture
  • Improved dental hygiene
    • Use of fluoridated water
    • Brushing regularly
  • Antibiotics
  • Dental extraction in case of severity
Parkinson's disease[34][35]
  • Clinical diagnosis
  • Improvement with dopaminergic therapy confirms diagnosis

References

  1. ↑ Anisha Doshi, Clare Warrell, Dima Dahdaleh & Dimitri Kullmann (2014). "Just a graze? Cephalic tetanus presenting as a stroke mimic". Practical neurology. 14 (1): 39–41. doi:10.1136/practneurol-2013-000541. PMID 24052566. Unknown parameter |month= ignored (help)
  2. ↑ E. Andreadou, E. Kattoulas, C. Sfagos & D. Vassilopoulos (2007). "Stiff person syndrome: avoiding misdiagnosis". Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology. 28 (1): 35–37. doi:10.1007/s10072-007-0745-9. PMID 17385093. Unknown parameter |month= ignored (help)
  3. ↑ Lisa Mitchell, William Adams & Francois Aspesberro (2017). "Case 6: Episodic Stiffness in a 30-month-old Girl". Pediatrics in review. 38 (1): 52–53. doi:10.1542/pir.2014-0142. PMID 28044038. Unknown parameter |month= ignored (help)
  4. ↑ P. D. Thompson, J. A. Obeso, G. Delgado, J. Gallego & C. D. Marsden (1986). "Focal dystonia of the jaw and the differential diagnosis of unilateral jaw and masticatory spasm". Journal of neurology, neurosurgery, and psychiatry. 49 (6): 651–656. PMID 3734821. Unknown parameter |month= ignored (help)
  5. ↑ P. D. Thompson, J. A. Obeso, G. Delgado, J. Gallego & C. D. Marsden (1986). "Focal dystonia of the jaw and the differential diagnosis of unilateral jaw and masticatory spasm". Journal of neurology, neurosurgery, and psychiatry. 49 (6): 651–656. PMID 3734821. Unknown parameter |month= ignored (help)
  6. ↑ J. R. Berger, W. A. Sheremata & E. Melamed (1984). "Paroxysmal dystonia as the initial manifestation of multiple sclerosis". Archives of neurology. 41 (7): 747–750. PMID 6743065. Unknown parameter |month= ignored (help)
  7. ↑ W. B. Matthews (1975). "Paroxysmal symptoms in multiple sclerosis". Journal of neurology, neurosurgery, and psychiatry. 38 (6): 617–623. PMID 1151430. Unknown parameter |month= ignored (help)
  8. ↑ P. D. Thompson & W. M. Carroll (1983). "Hemimasticatory spasm--a peripheral paroxysmal cranial neuropathy?". Journal of neurology, neurosurgery, and psychiatry. 46 (3): 274–276. PMID 6842234. Unknown parameter |month= ignored (help)
  9. ↑ P. D. Thompson & W. M. Carroll (1983). "Hemimasticatory and hemifacial spasm: a common pathophysiology?". Clinical and experimental neurology. 19: 110–119. PMID 6568919.
  10. ↑ L. R. Jenkyn, D. B. Walsh, C. M. Culver & A. G. Reeves (1977). "Clinical signs in diffuse cerebral dysfunction". Journal of neurology, neurosurgery, and psychiatry. 40 (10): 956–966. PMID 591973. Unknown parameter |month= ignored (help)
  11. ↑ J. D. Rugh & W. K. Solberg (1976). "Psychological implications in temporomandibular pain and dysfunction". Oral sciences reviews. 7: 3–30. PMID 775369.
  12. ↑ Bond WS (1984). "Detection and management of the neuroleptic malignant syndrome". Clin Pharm. 3 (3): 302–7. PMID 6145537.
  13. ↑ S. Fahn, S. B. Bressman & C. D. Marsden (1998). "Classification of dystonia". Advances in neurology. 78: 1–10. PMID 9750897.
  14. ↑ Howard L. Geyer & Susan B. Bressman (2006). "The diagnosis of dystonia". The Lancet. Neurology. 5 (9): 780–790. doi:10.1016/S1474-4422(06)70547-6. PMID 16914406. Unknown parameter |month= ignored (help)
  15. ↑ Christine Klein & Laurie J. Ozelius (2002). "Dystonia: clinical features, genetics, and treatment". Current opinion in neurology. 15 (4): 491–497. PMID 12151848. Unknown parameter |month= ignored (help)
  16. ↑ Woldeamanuel YW, Andemeskel AT, Kyei K, Woldeamanuel MW, Woldeamanuel W (2016). "Case fatality of adult tetanus in Africa: Systematic review and meta-analysis". J Neurol Sci. 368: 292–9. doi:10.1016/j.jns.2016.07.025. PMID 27538652.
  17. ↑ Thwaites CL, Loan HT (2015). "Eradication of tetanus". Br Med Bull. 116: 69–77. doi:10.1093/bmb/ldv044. PMC 4674006. PMID 26598719.
  18. ↑ Hosseini S, Elyasi F (2017). "Olanzapine-Induced Neuroleptic Malignant Syndrome". Iran J Med Sci. 42 (3): 306–309. PMC 5429500. PMID 28533580.
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  20. ↑ 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.
  21. ↑ 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.
  22. ↑ Tyler KL (2004). "Herpes simplex virus infections of the central nervous system: encephalitis and meningitis, including Mollaret's". Herpes. 11 Suppl 2: 57A–64A. PMID 15319091.
  23. ↑ Deng ZD, Li DY, Zhang CC, Pan YX, Zhang J, Jin H; et al. (2017). "Long-term follow-up of bilateral subthalamic deep brain stimulation for refractory tardive dystonia". Parkinsonism Relat Disord. doi:10.1016/j.parkreldis.2017.05.010. PMID 28552340.
  24. ↑ "Valbenazine (Ingrezza) for tardive dyskinesia". Med Lett Drugs Ther. 59 (1521): 83–84. 2017. PMID 28520698.
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  26. ↑ Charlotte Duverneuil, Geoffroy Lorin de la Grandmaison, Philippe de Mazancourt & Jean-Claude Alvarez (2004). "Liquid chromatography/photodiode array detection for determination of strychnine in blood: a fatal case report". Forensic science international. 141 (1): 17–21. doi:10.1016/j.forsciint.2003.12.010. PMID 15066709. Unknown parameter |month= ignored (help)
  27. ↑ B. A. Smith (1990). "Strychnine poisoning". The Journal of emergency medicine. 8 (3): 321–325. PMID 2197324. Unknown parameter |month= ignored (help)
  28. ↑ B. J. Maron, J. R. Krupp & B. Tune (1971). "Strychnine poisoning successfully treated with diazepam". The Journal of pediatrics. 78 (4): 697–699. PMID 5547830. Unknown parameter |month= ignored (help)
  29. ↑ B. Oberpaur, A. Donoso, C. Claveria, C. Valverde & M. Azocar (1999). "Strychnine poisoning: an uncommon intoxication in children". Pediatric emergency care. 15 (4): 264–265. PMID 10460082. Unknown parameter |month= ignored (help)
  30. ↑ Chhabra P, Rana SS, Sharma V, Sharma R, Bhasin DK (2016). "Hypocalcemic tetany: a simple bedside marker of poor outcome in acute pancreatitis". Ann Gastroenterol. 29 (2): 214–20. doi:10.20524/aog.2016.0015. PMC 4805743. PMID 27065735.
  31. ↑ Desai M, Kolla PK, Reddy PL (2013). "Calcium unresponsive hypocalcemic tetany: gitelman syndrome with hypocalcemia". Case Rep Med. 2013: 197374. doi:10.1155/2013/197374. PMC 3792521. PMID 24171002.
  32. ↑ Ogle OE (2017). "Odontogenic Infections". Dent Clin North Am. 61 (2): 235–252. doi:10.1016/j.cden.2016.11.004. PMID 28317564.
  33. ↑ Bertossi D, Barone A, Iurlaro A, Marconcini S, De Santis D, Finotti M; et al. (2017). "Odontogenic Orofacial Infections". J Craniofac Surg. 28 (1): 197–202. doi:10.1097/SCS.0000000000003250. PMID 27930461.
  34. ↑ Olanow CW, Watts RL, Koller WC (2001). "An algorithm (decision tree) for the management of Parkinson's disease (2001): treatment guidelines". Neurology. 56 (11 Suppl 5): S1–S88. PMID 11402154.
  35. ↑ Connolly BS, Lang AE (2014). "Pharmacological treatment of Parkinson disease: a review". JAMA. 311 (16): 1670–83. doi:10.1001/jama.2014.3654. PMID 24756517.

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