Neurosyphilis differential diagnosis: Difference between revisions
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{| | |||
|-style="background: #4479BA; color: #FFFFFF; text-align: center;" | |||
! rowspan="2" |<small>Diseases</small> | |||
! colspan="4" |<small>Diagnostic tests</small> | |||
! colspan="5" |<small>Physical Examination</small> | |||
! colspan="3" |<small>Symptoms | |||
! colspan="1" rowspan="2" |<small>Past medical history</small> | |||
! rowspan="2" |<small>Other Findings</small> | |||
|- style="background: #4479BA; color: #FFFFFF; text-align: center;" | |||
!<small>Na+, K+, Ca2+</small> | |||
!<small>CT /MRI</small> | |||
!<small>CSF Findings</small> | |||
!<small>Gold standard test</small> | |||
!<small>Neck stiffness</small> | |||
!<small>Motor or Sensory deficit</small> | |||
!<small>Papilledema</small> | |||
!<small>Bulging fontanelle</small> | |||
!<small>Cranial nerves</small> | |||
!<small>Headache</small> | |||
!<small>Fever</small> | |||
!<small>Altered mental status</small> | |||
|- | |||
|style="background: #DCDCDC; padding: 5px; text-align: center;" | [[Brain tumour]]<ref name="pmid1278192">Soffer D (1976) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=1278192 Brain tumors simulating purulent meningitis.] ''Eur Neurol'' 14 (3):192-7. PMID: [http://pubmed.gov/1278192 1278192]</ref><ref name="pmid3883130" /> | |||
|style="background: #F5F5F5; padding: 5px;" | | |||
|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; 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;" | | |||
|style="background: #F5F5F5; padding: 5px;" |[[Cachexia]], gradual progression of symptoms | |||
|- | |||
|style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Delirium tremens]] | |||
|style="background: #F5F5F5; padding: 5px;" | | |||
|style="background: #F5F5F5; padding: 5px; text-align:center" |✔ | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
| style="background: #F5F5F5; padding: 5px;" |Clinical diagnosis | |||
| 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;" |[[Alcohol]] intake, sudden witdrawl or reduction in consumption | |||
|style="background: #F5F5F5; padding: 5px;" |[[Tachycardia]], [[diaphoresis]], [[hypertension]], [[tremors]], [[mydriasis]], [[positional nystagmus]], | |||
|- | |||
|style="background: #DCDCDC; padding: 5px; text-align: center;" | [[Subarachnoid hemorrhage|Subarachnoid hemorrhage]]<ref name="pmid14585453">Yeh ST, Lee WJ, Lin HJ, Chen CY, Te AL, Lin HJ (2003) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=14585453 Nonaneurysmal subarachnoid hemorrhage secondary to tuberculous meningitis: report of two cases.] ''J Emerg Med'' 25 (3):265-70. PMID: [http://pubmed.gov/14585453 14585453]</ref> | |||
|style="background: #F5F5F5; padding: 5px;" | | |||
|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; 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;" |Trauma/fall | |||
|style="background: #F5F5F5; padding: 5px;" |[[Confusion]], [[dizziness]], [[Nausea and vomiting|nausea]], [[Nausea and vomiting|vomiting]] | |||
|- | |||
|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"| Normal | |||
|style="background: #F5F5F5; padding: 5px; text-align:center"| CT scan without contrast | |||
|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"|TIAs, [[hypertension]], [[diabetes mellitus]] | |||
|style="background: #F5F5F5; padding: 5px; text-align:center"|Speech difficulty, gait abnormality | |||
|- | |||
|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;" | | |||
|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; 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; text-align:center" |✔ | |||
|style="background: #F5F5F5; padding: 5px;" | | |||
|style="background: #F5F5F5; padding: 5px; text-align:center" |✔ | |||
|style="background: #F5F5F5; padding: 5px;" |Unprotected sexual intercourse, [[STI]]<nowiki/>s | |||
|style="background: #F5F5F5; padding: 5px;" |[[Blindness]], [[confusion]], [[depression]], | |||
Abnormal [[gait]] | |||
|- | |||
|style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Viral encephalitis]] | |||
|style="background: #F5F5F5; padding: 5px;" | | |||
|style="background: #F5F5F5; padding: 5px;" |✔ | |||
|style="background: #F5F5F5; padding: 5px;" |Increased [[RBC]]S or xanthochromia, [[Mononuclear cells|mononuclear]] [[lymphocytosis]], high protein content, normal [[glucose]] | |||
|style="background: #F5F5F5; padding: 5px;" |Clinical assesment | |||
|style="background: #F5F5F5; padding: 5px;" |✔ | |||
|style="background: #F5F5F5; padding: 5px;" |✔ | |||
|style="background: #F5F5F5; padding: 5px;text-align:center" |✔ | |||
|style="background: #F5F5F5; padding: 5px;" | | |||
| style="background: #F5F5F5; padding: 5px;" | ✔ | |||
|style="background: #F5F5F5; padding: 5px; text-align:center" |✔ | |||
|style="background: #F5F5F5; padding: 5px;" |✔ | |||
|style="background: #F5F5F5; padding: 5px;" |✔ | |||
| style="background: #F5F5F5; padding: 5px;" |Tick bite/mosquito bite/ viral prodome for several days | |||
| style="background: #F5F5F5; padding: 5px;" |Extreme lethargy, rash [[hepatosplenomegaly]], [[lymphadenopathy]], [[behavioural]] changes | |||
|- | |||
|style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Herpes simplex encephalitis]] | |||
|style="background: #F5F5F5; padding: 5px;" | | |||
|style="background: #F5F5F5; padding: 5px;" |✔ | |||
|style="background: #F5F5F5; padding: 5px;" | | |||
|style="background: #F5F5F5; padding: 5px;" |Clinical assesment | |||
|style="background: #F5F5F5; padding: 5px;" | | |||
|style="background: #F5F5F5; padding: 5px;" | | |||
|style="background: #F5F5F5; padding: 5px;" |✔ | |||
|style="background: #F5F5F5; padding: 5px;" |✔ | |||
|style="background: #F5F5F5; padding: 5px;" |✔ | |||
|style="background: #F5F5F5; padding: 5px;" |✔ | |||
|style="background: #F5F5F5; padding: 5px;" |✔ | |||
|style="background: #F5F5F5; padding: 5px;" | | |||
|style="background: #F5F5F5; padding: 5px;" |History of [[hypertension]] | |||
|style="background: #F5F5F5; padding: 5px;" |[[Delirium]], cortical [[blindness]], [[cerebral edema]], [[seizure]] | |||
|- | |||
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Wernicke’s encephalopathy | |||
|style="background: #F5F5F5; padding: 5px;" | | |||
|style="background: #F5F5F5; padding: 5px;" | | |||
|style="background: #F5F5F5; padding: 5px;" |Normal | |||
|style="background: #F5F5F5; padding: 5px;" | | |||
|style="background: #F5F5F5; padding: 5px;" | | |||
|style="background: #F5F5F5; padding: 5px;" | | |||
|style="background: #F5F5F5; padding: 5px;" |✔ | |||
|style="background: #F5F5F5; padding: 5px;" |✔ | |||
|style="background: #F5F5F5; padding: 5px;" | | |||
|style="background: #F5F5F5; padding: 5px;" | | |||
|style="background: #F5F5F5; padding: 5px;" |✔ | |||
|style="background: #F5F5F5; padding: 5px;" | | |||
|style="background: #F5F5F5; padding: 5px;" |History of alcohal abuse | |||
|style="background: #F5F5F5; padding: 5px;" |[[Ophthalmoplegia]], [[confusion]] | |||
|- | |||
|style="background: #DCDCDC; padding: 5px; text-align: center;" |[[CNS abscess]] | |||
|style="background: #F5F5F5; padding: 5px;" | | |||
|style="background: #F5F5F5; padding: 5px;" |✔ | |||
|style="background: #F5F5F5; padding: 5px;" |'''↑''' [[leukocytes]] >100,000/ul, '''↓''' [[glucose]] and '''↑''' protien, '''↑''' red blood cells, [[lactic acid]] >500mg | |||
|style="background: #F5F5F5; padding: 5px;" |Contrast enhanced MRI is more sensitive and specific, | |||
[[Histopathological]] examination of brain tissue | |||
|style="background: #F5F5F5; padding: 5px;" |✔ | |||
|style="background: #F5F5F5; padding: 5px;" |✔ | |||
|style="background: #F5F5F5; padding: 5px;" |✔ | |||
|style="background: #F5F5F5; padding: 5px;" | | |||
|style="background: #F5F5F5; padding: 5px;" |✔ | |||
|style="background: #F5F5F5; padding: 5px;" |✔ | |||
|style="background: #F5F5F5; padding: 5px;" |✔ | |||
|style="background: #F5F5F5; padding: 5px;" |✔ | |||
|style="background: #F5F5F5; padding: 5px;" |History of [[drug abuse]], [[endocarditis]], '''↓''' [[immune]] status | |||
|style="background: #F5F5F5; padding: 5px;" |High grade [[fever]], [[fatigue]],[[Nausea and vomiting|nausea]], [[vomiting]] | |||
|- | |||
|style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Drug toxicity]] | |||
|style="background: #F5F5F5; padding: 5px;" | | |||
|style="background: #F5F5F5; padding: 5px;" | | |||
|style="background: #F5F5F5; padding: 5px;" | | |||
|style="background: #F5F5F5; padding: 5px;" | | |||
|style="background: #F5F5F5; padding: 5px;" | | |||
|style="background: #F5F5F5; padding: 5px;" | | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
|style="background: #F5F5F5; padding: 5px;" | | |||
|style="background: #F5F5F5; padding: 5px;" | | |||
|style="background: #F5F5F5; padding: 5px;" |✔ | |||
|style="background: #F5F5F5; padding: 5px;" |✔ | |||
|style="background: #F5F5F5; padding: 5px;" | | |||
|style="background: #F5F5F5; padding: 5px;" |[[Lithium]], Sedatives, [[phenytoin]], [[carbamazepine]] | |||
|- | |||
|style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Conversion disorder]] | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
|style="background: #F5F5F5; padding: 5px;" | | |||
|style="background: #F5F5F5; padding: 5px;" | | |||
|style="background: #F5F5F5; padding: 5px;" |Diagnosis of exclusion | |||
| 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; 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;" |[[Tremor|Tremors]], [[blindness]], difficulty [[swallowing]] | |||
|- | |||
|style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Electrolyte disturbance]] | |||
|style="background: #F5F5F5; padding: 5px; text-align:center" |'''↓''' or '''↑''' | |||
|style="background: #F5F5F5; padding: 5px;" | | |||
|style="background: #F5F5F5; padding: 5px;" | | |||
|style="background: #F5F5F5; padding: 5px;" |Depends on the cause | |||
|style="background: #F5F5F5; padding: 5px;" | | |||
|style="background: #F5F5F5; padding: 5px;" | | |||
|style="background: #F5F5F5; padding: 5px;" | | |||
|style="background: #F5F5F5; padding: 5px;" | | |||
|style="background: #F5F5F5; padding: 5px;" | | |||
|style="background: #F5F5F5; padding: 5px;" |✔ | |||
|style="background: #F5F5F5; padding: 5px;" | | |||
|style="background: #F5F5F5; padding: 5px;" |✔ | |||
|style="background: #F5F5F5; padding: 5px;" | | |||
|style="background: #F5F5F5; padding: 5px;" |[[Confusion]], [[Seizure|seizures]] | |||
|- | |||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Febrile convulsion]] | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
| style="background: #F5F5F5; padding: 5px; text-align:center" |Not performed in first simple febrile [[seizures]] | |||
| style="background: #F5F5F5; padding: 5px;" |Clinical diagnosis and EEG | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
| 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;" |Family history of [[febrile]] [[seizures]], [[viral]] illness or [[gastroenteritis]] | |||
| style="background: #F5F5F5; padding: 5px;" |Age > 1 month, | |||
|- | |||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Subdural empyema]] | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
| style="background: #F5F5F5; padding: 5px; text-align:center" |✔ | |||
| style="background: #F5F5F5; padding: 5px; text-align:center" | | |||
| style="background: #F5F5F5; padding: 5px;" |Clinical assesment and [[MRI]] | |||
| 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; text-align:center" |✔ | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
| style="background: #F5F5F5; padding: 5px; text-align:center" |✔ | |||
| style="background: #F5F5F5; padding: 5px;" |History of relapses and remissions | |||
| style="background: #F5F5F5; padding: 5px;" |Blurry vision, [[urinary incontinence]], [[fatigue]] | |||
|- | |||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Hypoglycemia]] | |||
| style="background: #F5F5F5; padding: 5px; text-align:center" |↓ or '''↑''' | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
| style="background: #F5F5F5; padding: 5px;" |Serum blood [[Glucose-1-phosphate adenylyltransferase|glucose]] | |||
[[HbA1c]] | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
| style="background: #F5F5F5; padding: 5px;" |✔ | |||
| 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; text-align:center" | ✔ | |||
| style="background: #F5F5F5; padding: 5px; text-align:center" | | |||
| style="background: #F5F5F5; padding: 5px;" |✔ | |||
| style="background: #F5F5F5; padding: 5px;" |History of [[Diabetes mellitus|diabetes]] | |||
| style="background: #F5F5F5; padding: 5px;" |[[Palpitation|Palpitations]], [[sweating]], [[dizziness]], low serum, [[glucose]] | |||
|} | |||
==References== | ==References== | ||
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| Diseases | Diagnostic tests | Physical Examination | Symptoms | Past medical history | Other Findings | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Na+, K+, Ca2+ | CT /MRI | CSF Findings | Gold standard test | Neck stiffness | Motor or Sensory deficit | Papilledema | Bulging fontanelle | Cranial nerves | Headache | Fever | Altered mental status | |||
| Brain tumour[1][2] | ✔ | Cancer cells[3] | MRI | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | Cachexia, gradual progression of symptoms | ||||
| Delirium tremens | ✔ | Clinical diagnosis | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | Alcohol intake, sudden witdrawl or reduction in consumption | Tachycardia, diaphoresis, hypertension, tremors, mydriasis, positional nystagmus, | ||||
| Subarachnoid hemorrhage[4] | ✔ | Xanthochromia[5] | CT scan without contrast[6][7] | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | Trauma/fall | Confusion, dizziness, nausea, vomiting | |
| Stroke | ✔ | Normal | CT scan without contrast | ✔ | ✔ | ✔ | ✔ | ✔ | TIAs, hypertension, diabetes mellitus | Speech difficulty, gait abnormality | ||||
| Neurosyphilis[8][9] | ✔ | ↑ Leukocytes and protein | CSF VDRL-specifc
CSF FTA-Ab -sensitive[10] |
✔ | ✔ | ✔ | ✔ | ✔ | ✔ | Unprotected sexual intercourse, STIs | Blindness, confusion, depression,
Abnormal gait | |||
| Viral encephalitis | ✔ | Increased RBCS or xanthochromia, mononuclear lymphocytosis, high protein content, normal glucose | Clinical assesment | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | Tick bite/mosquito bite/ viral prodome for several days | Extreme lethargy, rash hepatosplenomegaly, lymphadenopathy, behavioural changes | ||
| Herpes simplex encephalitis | ✔ | Clinical assesment | ✔ | ✔ | ✔ | ✔ | ✔ | History of hypertension | Delirium, cortical blindness, cerebral edema, seizure | |||||
| Wernicke’s encephalopathy | Normal | ✔ | ✔ | ✔ | History of alcohal abuse | Ophthalmoplegia, confusion | ||||||||
| CNS abscess | ✔ | ↑ leukocytes >100,000/ul, ↓ glucose and ↑ protien, ↑ red blood cells, lactic acid >500mg | Contrast enhanced MRI is more sensitive and specific,
Histopathological examination of brain tissue |
✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | History of drug abuse, endocarditis, ↓ immune status | High grade fever, fatigue,nausea, vomiting | ||
| Drug toxicity | ✔ | ✔ | Lithium, Sedatives, phenytoin, carbamazepine | |||||||||||
| Conversion disorder | Diagnosis of exclusion | ✔ | ✔ | ✔ | ✔ | ✔ | Tremors, blindness, difficulty swallowing | |||||||
| Electrolyte disturbance | ↓ or ↑ | Depends on the cause | ✔ | ✔ | Confusion, seizures | |||||||||
| Febrile convulsion | Not performed in first simple febrile seizures | Clinical diagnosis and EEG | ✔ | ✔ | ✔ | ✔ | Family history of febrile seizures, viral illness or gastroenteritis | Age > 1 month, | ||||||
| Subdural empyema | ✔ | Clinical assesment and MRI | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | History of relapses and remissions | Blurry vision, urinary incontinence, fatigue | ||||
| Hypoglycemia | ↓ or ↑ | Serum blood glucose | ✔ | ✔ | ✔ | History of diabetes | Palpitations, sweating, dizziness, low serum, glucose | |||||||
References
- ↑ Soffer D (1976) Brain tumors simulating purulent meningitis. Eur Neurol 14 (3):192-7. PMID: 1278192
- ↑
- ↑ 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.
- ↑ Yeh ST, Lee WJ, Lin HJ, Chen CY, Te AL, Lin HJ (2003) Nonaneurysmal subarachnoid hemorrhage secondary to tuberculous meningitis: report of two cases. J Emerg Med 25 (3):265-70. PMID: 14585453
- ↑ Lee MC, Heaney LM, Jacobson RL, Klassen AC (1975). "Cerebrospinal fluid in cerebral hemorrhage and infarction". Stroke. 6 (6): 638–41. PMID 1198628.
- ↑ Birenbaum D, Bancroft LW, Felsberg GJ (2011). "Imaging in acute stroke". West J Emerg Med. 12 (1): 67–76. PMC 3088377. PMID 21694755.
- ↑ 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.
- ↑ 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.