Hemorrhagic stroke differential diagnosis: Difference between revisions

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Revision as of 19:04, 16 November 2016

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Differential diagnosis

^[1]^[2]


Disease	Findings
Ischemic stroke	Occurs when a clot or a mass clogs a blood vessel and cutting off the blood flow to the brain Present as a Thrombotic stroke (thrombus develops at the clogged part of the vessel) Embolic strokes (blood clot that forms at another locations usually the heart and large arteries of the upper chest and neck, and travels to the brain) Urgent evaluation with brain / neurovascular imaging (such as MRI, CT, CTA, MRA), cardiac, and metabolic evaluation is often necessary
transient ischemic attack (TIA)	Caused by a temporary clot which often called a “mini stroke” Occurs rapidly and presents as a sudden onset of a focal neurologic symptom/sign lasting less than 24 hours Urgent evaluation with brain / neurovascular imaging (such as MRI, CT, CTA, MRA), cardiac, and metabolic evaluation is often necessary
Acute hypertensive crisis/Malignant hypertension	Presents as significantly elevated blood pressure (systolic pressure ≥180 and/or diastolic pressure ≥120 mmHg) with or wihout acute end-organ injury Urgent evaluation with MRI and CT of the brain, serum creatinine, urinalysis, cardiac (EKG, chest x ray, and cardiac enzymes) and metabolic evaluation is often necessary
Sentinel headache^[3]	Caused by small aneurysmal leaks into the subarachnoid space Presents as a episode of headache similar to that accompanying subarachnoid hemorrhage (days to weeks prior to aneurysm rupture) and focal neurologic symptoms and signs are usually absent
Sinusitis	Presents with acute and subacute headaches and facial pain
Hypoglycemia
Pituitary apoplexy^[4]	Caused by pituitary gland infarct or hemorrhage secondary to pitutiery adenoma Presents with acute headache, change in mental status, ophthalmoplegia, and decreased visual acuity Brain CT and MRI are the preferred imaging techniques
Cerebral venous thrombosis^[5]^[6]	Presents with isolated gradual onset headache or in combination with papilledema, seizures, bilateral focal deficits, and change in mental status Brain MRI with venography should be considered
Colloid cyst of the third ventricle^[7]	Caused by an acute obstructive hydrocephalus secondary to sudden obstruction in cerebrospinal fluid flow by the cyst Presents with an acute onset fronto-parietal or fronto-occipital headache which relieved by taking the supine position and may be associated with nausea, vomiting, mental status changes, seizures, coma Head CT or MRI of the brain are usually diagnostic
Cervical artery dissection^[8]^[9]	It usulay occurs spontaneously or after head and neck injury Presents with gradual onset head and neck pain with a local manifestations (such as Horner syndrome, pulsatile tinnitus, bruit, or cranial neuropathies) Neuroimagings are usually preferred (brain MRI with MRA and cranial CT with CTA)
Reversible cerebral vasoconstriction syndrome	Occurs spontaneously and trigerred by sexual activity, exertion, emotion, and constriction of the cerebral arteries Presents with acute severe headache with or without focal deficits or seizures that resolves spontaneously within 12 weeks
Spontaneous intracranial hypotension^[10]^[11]	Presents with orthostatic headaches, nausea, vomiting, dizziness, diplopia, interscapular pain Caused by cerebrospinal fluid (CSF) leakage from spinal meningeal defects or dural tears Brain MRI is the preferred imaging techniques

Diseases	Diagnostic tests				Physical Examination					Symptoms				Past medical history	Other Findings
Diseases	Na+, K+, Ca2+	CT /MRI	CSF Findings	Gold standard test	Motor Deficit	Sensory deficit	Speech difficulty	Gait abnormality	Cranial nerves	Headache	LOC	Motor weakness	Abnormal sensations		Other Findings
Brain tumour^[12]		✔	Cancer cells^[13]	MRI	✔	✔	✔	✔	✔	✔					Cachexia
Hemorrhagic stroke		✔	Xanthochromia^[14]	CT scan without contrast^[15]^[16]	✔	✔	✔	✔	✔	✔	✔	✔		Hypertension	Neck stiffness
Subdural hemorrhage		✔		CT scan without contrast^[15]^[16]	✔	✔	✔	✔	✔	✔	✔	✔		Trauma/fall	Confusion, dizziness, nausea, vomiting
Neurosyphilis^[17]^[18]		✔	↑ Leukocytes and protein	CSF VDRL-specifc CSF FTA-Ab -sensitive^[19]	✔	✔	✔	✔		✔		✔	✔	STIs	Blindness, confusion, depression, Abnormal gait
Complex or atypical migraine				Clinical assesment			✔			✔			✔	Family history of migraine	Presence of aura, nausea, vomiting
Conversion disorder				Diagnosis of exclusion	✔	✔	✔	✔		✔	✔	✔	✔		Tremors, blindness, difficulty swallowing
Electrolyte disturbance	↓ or ↑			Depends on the cause											Confusion, seizures
Meningitis or encephalitis			↑ Leukocytes, ↑ Protein ↓ Glucose	CSF analysis^[20]					✔	✔					Fever, neck rigidity
Multiple sclerosis exacerbation		✔	↑ CSF IgG levels (monoclonal bands)	Clinical assesment and MRI ^[21]	✔	✔	✔	✔	✔			✔	✔	History of relapses and remissions	Blurry vision, urinary incontinence, fatigue
Seizure	↓ or ↑			Clinical assesment and EEG ^[22]	✔					✔	✔		✔	Previous history of seizures	Confusion, apathy, irritability,
Hypoglycemia or hyperglycemia	↓ or ↑			Serum blood glucose HbA1c			✔	✔		✔	✔		✔	History of diabetes	Palpitations, sweating, dizziness

References

↑ Linn FH, Rinkel GJ, Algra A, van Gijn J (1998). "Headache characteristics in subarachnoid haemorrhage and benign thunderclap headache". J Neurol Neurosurg Psychiatry. 65 (5): 791–3. PMC 2170334. PMID 9810961.
↑ Markus HS (1991). "A prospective follow up of thunderclap headache mimicking subarachnoid haemorrhage". J Neurol Neurosurg Psychiatry. 54 (12): 1117–8. PMC 1014694. PMID 1783930.
↑ Polmear A (2003). "Sentinel headaches in aneurysmal subarachnoid haemorrhage: what is the true incidence? A systematic review". Cephalalgia. 23 (10): 935–41. PMID 14984225.
↑ Dodick DW, Wijdicks EF (1998). "Pituitary apoplexy presenting as a thunderclap headache". Neurology. 50 (5): 1510–1. PMID 9596029.
↑ de Bruijn SF, Stam J, Kappelle LJ (1996). "Thunderclap headache as first symptom of cerebral venous sinus thrombosis. CVST Study Group". Lancet. 348 (9042): 1623–5. PMID 8961993.
↑ Bousser MG, Chiras J, Bories J, Castaigne P (1985). "Cerebral venous thrombosis--a review of 38 cases". Stroke. 16 (2): 199–213. PMID 3975957.
↑ KELLY R (1951). "Colloid cysts of the third ventricle; analysis of twenty-nine cases". Brain. 74 (1): 23–65. PMID 14830663.
↑ Mitsias P, Ramadan NM (1992). "Headache in ischemic cerebrovascular disease. Part I: Clinical features". Cephalalgia. 12 (5): 269–74. PMID 1423556.
↑ Touzé E, Gauvrit JY, Moulin T, Meder JF, Bracard S, Mas JL; et al. (2003). "Risk of stroke and recurrent dissection after a cervical artery dissection: a multicenter study". Neurology. 61 (10): 1347–51. PMID 14638953.
↑ Rando TA, Fishman RA (1992). "Spontaneous intracranial hypotension: report of two cases and review of the literature". Neurology. 42 (3 Pt 1): 481–7. PMID 1549206.
↑ Schievink WI, Wijdicks EF, Meyer FB, Sonntag VK (2001). "Spontaneous intracranial hypotension mimicking aneurysmal subarachnoid hemorrhage". Neurosurgery. 48 (3): 513–6, discussion 516-7. PMID 11270540.
↑ Morgenstern LB, Frankowski RF (1999). "Brain tumor masquerading as stroke". J Neurooncol. 44 (1): 47–52. PMID 10582668.
↑ Weston CL, Glantz MJ, Connor JR (2011). "Detection of cancer cells in the cerebrospinal fluid: current methods and future directions". Fluids Barriers CNS. 8 (1): 14. doi:10.1186/2045-8118-8-14. PMC 3059292. PMID 21371327.
↑ Lee MC, Heaney LM, Jacobson RL, Klassen AC (1975). "Cerebrospinal fluid in cerebral hemorrhage and infarction". Stroke. 6 (6): 638–41. PMID 1198628.
↑ ^15.0 ^15.1 Birenbaum D, Bancroft LW, Felsberg GJ (2011). "Imaging in acute stroke". West J Emerg Med. 12 (1): 67–76. PMC 3088377. PMID 21694755.
↑ ^16.0 ^16.1 DeLaPaz RL, Wippold FJ, Cornelius RS, Amin-Hanjani S, Angtuaco EJ, Broderick DF; et al. (2011). "ACR Appropriateness Criteria® on cerebrovascular disease". J Am Coll Radiol. 8 (8): 532–8. doi:10.1016/j.jacr.2011.05.010. PMID 21807345.
↑ Liu LL, Zheng WH, Tong ML, Liu GL, Zhang HL, Fu ZG; et al. (2012). "Ischemic stroke as a primary symptom of neurosyphilis among HIV-negative emergency patients". J Neurol Sci. 317 (1–2): 35–9. doi:10.1016/j.jns.2012.03.003. PMID 22482824.
↑ Berger JR, Dean D (2014). "Neurosyphilis". Handb Clin Neurol. 121: 1461–72. doi:10.1016/B978-0-7020-4088-7.00098-5. PMID 24365430.
↑ Ho EL, Marra CM (2012). "Treponemal tests for neurosyphilis--less accurate than what we thought?". Sex Transm Dis. 39 (4): 298–9. doi:10.1097/OLQ.0b013e31824ee574. PMC 3746559. PMID 22421697.
↑ Carbonnelle E (2009). "[Laboratory diagnosis of bacterial meningitis: usefulness of various tests for the determination of the etiological agent]". Med Mal Infect. 39 (7–8): 581–605. doi:10.1016/j.medmal.2009.02.017. PMID 19398286.
↑ Giang DW, Grow VM, Mooney C, Mushlin AI, Goodman AD, Mattson DH; et al. (1994). "Clinical diagnosis of multiple sclerosis. The impact of magnetic resonance imaging and ancillary testing. Rochester-Toronto Magnetic Resonance Study Group". Arch Neurol. 51 (1): 61–6. PMID 8274111.
↑ Manford M (2001). "Assessment and investigation of possible epileptic seizures". J Neurol Neurosurg Psychiatry. 70 Suppl 2: II3–8. PMC 1765557. PMID 11385043.

Template:WS Template:WH

[pmid9810961-1] Linn FH, Rinkel GJ, Algra A, van Gijn J (1998). "Headache characteristics in subarachnoid haemorrhage and benign thunderclap headache". J Neurol Neurosurg Psychiatry. 65 (5): 791–3. PMC 2170334. PMID 9810961.

[pmid1783930-2] Markus HS (1991). "A prospective follow up of thunderclap headache mimicking subarachnoid haemorrhage". J Neurol Neurosurg Psychiatry. 54 (12): 1117–8. PMC 1014694. PMID 1783930.

[pmid14984225-3] Polmear A (2003). "Sentinel headaches in aneurysmal subarachnoid haemorrhage: what is the true incidence? A systematic review". Cephalalgia. 23 (10): 935–41. PMID 14984225.

[pmid9596029-4] Dodick DW, Wijdicks EF (1998). "Pituitary apoplexy presenting as a thunderclap headache". Neurology. 50 (5): 1510–1. PMID 9596029.

[pmid8961993-5] Bruijn SF, Stam J, Kappelle LJ (1996). "Thunderclap headache as first symptom of cerebral venous sinus thrombosis. CVST Study Group". Lancet. 348 (9042): 1623–5. PMID 8961993.

[pmid3975957-6] Bousser MG, Chiras J, Bories J, Castaigne P (1985). "Cerebral venous thrombosis--a review of 38 cases". Stroke. 16 (2): 199–213. PMID 3975957.

[pmid14830663-7] KELLY R (1951). "Colloid cysts of the third ventricle; analysis of twenty-nine cases". Brain. 74 (1): 23–65. PMID 14830663.

[pmid1423556-8] Mitsias P, Ramadan NM (1992). "Headache in ischemic cerebrovascular disease. Part I: Clinical features". Cephalalgia. 12 (5): 269–74. PMID 1423556.

[pmid14638953-9] Touzé E, Gauvrit JY, Moulin T, Meder JF, Bracard S, Mas JL; et al. (2003). "Risk of stroke and recurrent dissection after a cervical artery dissection: a multicenter study". Neurology. 61 (10): 1347–51. PMID 14638953.

[pmid1549206-10] Rando TA, Fishman RA (1992). "Spontaneous intracranial hypotension: report of two cases and review of the literature". Neurology. 42 (3 Pt 1): 481–7. PMID 1549206.

[pmid11270540-11] Schievink WI, Wijdicks EF, Meyer FB, Sonntag VK (2001). "Spontaneous intracranial hypotension mimicking aneurysmal subarachnoid hemorrhage". Neurosurgery. 48 (3): 513–6, discussion 516-7. PMID 11270540.

[pmid10582668-12] Morgenstern LB, Frankowski RF (1999). "Brain tumor masquerading as stroke". J Neurooncol. 44 (1): 47–52. PMID 10582668.

[pmid21371327-13] 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.

[pmid1198628-14] Lee MC, Heaney LM, Jacobson RL, Klassen AC (1975). "Cerebrospinal fluid in cerebral hemorrhage and infarction". Stroke. 6 (6): 638–41. PMID 1198628.

[pmid21694755-15] 15.0 ^15.1 Birenbaum D, Bancroft LW, Felsberg GJ (2011). "Imaging in acute stroke". West J Emerg Med. 12 (1): 67–76. PMC 3088377. PMID 21694755.

[pmid21807345-16] 16.0 ^16.1 DeLaPaz RL, Wippold FJ, Cornelius RS, Amin-Hanjani S, Angtuaco EJ, Broderick DF; et al. (2011). "ACR Appropriateness Criteria® on cerebrovascular disease". J Am Coll Radiol. 8 (8): 532–8. doi:10.1016/j.jacr.2011.05.010. PMID 21807345.

[pmid22482824-17] Liu LL, Zheng WH, Tong ML, Liu GL, Zhang HL, Fu ZG; et al. (2012). "Ischemic stroke as a primary symptom of neurosyphilis among HIV-negative emergency patients". J Neurol Sci. 317 (1–2): 35–9. doi:10.1016/j.jns.2012.03.003. PMID 22482824.

[pmid24365430-18] Berger JR, Dean D (2014). "Neurosyphilis". Handb Clin Neurol. 121: 1461–72. doi:10.1016/B978-0-7020-4088-7.00098-5. PMID 24365430.

[pmid22421697-19] Ho EL, Marra CM (2012). "Treponemal tests for neurosyphilis--less accurate than what we thought?". Sex Transm Dis. 39 (4): 298–9. doi:10.1097/OLQ.0b013e31824ee574. PMC 3746559. PMID 22421697.

[pmid19398286-20] Carbonnelle E (2009). "[Laboratory diagnosis of bacterial meningitis: usefulness of various tests for the determination of the etiological agent]". Med Mal Infect. 39 (7–8): 581–605. doi:10.1016/j.medmal.2009.02.017. PMID 19398286.

[pmid8274111-21] Giang DW, Grow VM, Mooney C, Mushlin AI, Goodman AD, Mattson DH; et al. (1994). "Clinical diagnosis of multiple sclerosis. The impact of magnetic resonance imaging and ancillary testing. Rochester-Toronto Magnetic Resonance Study Group". Arch Neurol. 51 (1): 61–6. PMID 8274111.

[pmid11385043-22] Manford M (2001). "Assessment and investigation of possible epileptic seizures". J Neurol Neurosurg Psychiatry. 70 Suppl 2: II3–8. PMC 1765557. PMID 11385043.

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@@ Line 78: / Line 78: @@
 *Caused by [[cerebrospinal fluid|cerebrospinal fluid (CSF)]] leakage from spinal meningeal defects or [[dural]] tears
 *Brain MRI is the preferred imaging techniques
+|}
+{|
+|-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="4" |<small>Symptoms
+! colspan="1" |<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>Motor Deficit</small>
+!<small>Sensory deficit</small>
+!<small>Speech difficulty</small>
+!<small>Gait abnormality</small>
+!<small>Cranial nerves</small>
+!<small>Headache</small>
+!<small>LOC</small>
+!<small>Motor weakness</small>
+!<small>Abnormal sensations</small>
+!
+|-
+|style="background: #DCDCDC; padding: 5px; text-align: center;" | Brain tumour<ref name="pmid10582668">{{cite journal| author=Morgenstern LB, Frankowski RF| title=Brain tumor masquerading as stroke. | journal=J Neurooncol | year= 1999 | volume= 44 | issue= 1 | pages= 47-52 | pmid=10582668 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10582668  }} </ref>
+|style="background: #F5F5F5; padding: 5px;" |
+|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;" |
+|style="background: #F5F5F5; padding: 5px;" |[[Cachexia]]
+|-
+|style="background: #DCDCDC; padding: 5px; text-align: center;" |Hemorrhagic stroke
+|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;" |
+|style="background: #F5F5F5; padding: 5px;" |[[Hypertension]]
+|style="background: #F5F5F5; padding: 5px;" |Neck stiffness
+|-
+|style="background: #DCDCDC; padding: 5px; text-align: center;" | Subdural hemorrhage
+|style="background: #F5F5F5; padding: 5px;" |
+|style="background: #F5F5F5; padding: 5px; text-align:center" |✔
+|style="background: #F5F5F5; padding: 5px;" |
+|style="background: #F5F5F5; padding: 5px;" |CT scan  without contrast<ref name="pmid21694755">{{cite journal| author=Birenbaum D, Bancroft LW, Felsberg GJ| title=Imaging in acute stroke. | journal=West J Emerg Med | year= 2011 | volume= 12 | issue= 1 | pages= 67-76 | pmid=21694755 | doi= | pmc=3088377 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21694755  }}</ref><ref name="pmid21807345">{{cite journal| author=DeLaPaz RL, Wippold FJ, Cornelius RS, Amin-Hanjani S, Angtuaco EJ, Broderick DF et al.| title=ACR Appropriateness Criteria® on cerebrovascular disease. | journal=J Am Coll Radiol | year= 2011 | volume= 8 | issue= 8 | pages= 532-8 | pmid=21807345 | doi=10.1016/j.jacr.2011.05.010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21807345  }}</ref>
+|style="background: #F5F5F5; padding: 5px; text-align:center" |✔
+|style="background: #F5F5F5; padding: 5px; text-align:center" |✔
+|style="background: #F5F5F5; padding: 5px;text-align:center" |✔
+|style="background: #F5F5F5; padding: 5px;text-align:center" |✔
+| style="background: #F5F5F5; padding: 5px; text-align:center" |     ✔
+|style="background: #F5F5F5; padding: 5px; text-align:center" |✔
+|style="background: #F5F5F5; padding: 5px; text-align:center" |✔
+|style="background: #F5F5F5; padding: 5px; text-align:center" |✔
+|style="background: #F5F5F5; padding: 5px;" |
+|style="background: #F5F5F5; padding: 5px;" |Trauma/fall
+|style="background: #F5F5F5; padding: 5px;" |Confusion, dizziness, nausea, vomiting
+|-
+|style="background: #DCDCDC; padding: 5px; text-align: center;" |Neurosyphilis<ref name="pmid22482824">{{cite journal| author=Liu LL, Zheng WH, Tong ML, Liu GL, Zhang HL, Fu ZG et al.| title=Ischemic stroke as a primary symptom of neurosyphilis among HIV-negative emergency patients. | journal=J Neurol Sci | year= 2012 | volume= 317 | issue= 1-2 | pages= 35-9 | pmid=22482824 | doi=10.1016/j.jns.2012.03.003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22482824  }} </ref><ref name="pmid24365430">{{cite journal |vauthors=Berger JR, Dean D |title=Neurosyphilis |journal=Handb Clin Neurol |volume=121 |issue= |pages=1461–72 |year=2014 |pmid=24365430 |doi=10.1016/B978-0-7020-4088-7.00098-5 |url=}}</ref>
+|style="background: #F5F5F5; padding: 5px;" |
+|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; text-align:center" |✔
+|style="background: #F5F5F5; padding: 5px;" |STIs
+|style="background: #F5F5F5; padding: 5px;" |Blindness, confusion, [[depression]],
+Abnormal [[gait]]
+|-
+|style="background: #DCDCDC; padding: 5px; text-align: center;" |Complex or atypical migraine
+|style="background: #F5F5F5; padding: 5px;" |
+|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;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;" |Family history of [[migraine]]
+|style="background: #F5F5F5; padding: 5px;" |Presence of aura, [[nausea]], [[vomiting]]
+|-
+|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; 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;" |
+|style="background: #F5F5F5; padding: 5px;" |Confusion, seizures
+|-
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |Meningitis or encephalitis
+| style="background: #F5F5F5; padding: 5px;" |
+| style="background: #F5F5F5; padding: 5px;" |
+| style="background: #F5F5F5; padding: 5px; text-align:center" |'''↑''' Leukocytes,
+'''↑''' Protein
+↓ Glucose
+| style="background: #F5F5F5; padding: 5px;" |[[CSF analysis]]<ref name="pmid19398286">{{cite journal| author=Carbonnelle E| title=[Laboratory diagnosis of bacterial meningitis: usefulness of various tests for the determination of the etiological agent]. | journal=Med Mal Infect | year= 2009 | volume= 39 | issue= 7-8 | pages= 581-605 | pmid=19398286 | doi=10.1016/j.medmal.2009.02.017 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19398286  }}</ref>
+| style="background: #F5F5F5; padding: 5px;" |
+| 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;" |
+| style="background: #F5F5F5; padding: 5px;" |
+| style="background: #F5F5F5; padding: 5px;" |[[Fever]], neck
+rigidity
+|-
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |Multiple sclerosis exacerbation
+| style="background: #F5F5F5; padding: 5px;" |
+| style="background: #F5F5F5; padding: 5px; text-align:center" |✔
+| style="background: #F5F5F5; padding: 5px; text-align:center" |'''↑'''  CSF IgG levels
+(monoclonal bands)
+| style="background: #F5F5F5; padding: 5px;" |Clinical assesment and [[MRI]] <ref name="pmid8274111">{{cite journal| author=Giang DW, Grow VM, Mooney C, Mushlin AI, Goodman AD, Mattson DH et al.| title=Clinical diagnosis of multiple sclerosis. The impact of magnetic resonance imaging and ancillary testing. Rochester-Toronto Magnetic Resonance Study Group. | journal=Arch Neurol | year= 1994 | volume= 51 | issue= 1 | pages= 61-6 | pmid=8274111 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8274111  }}</ref>
+| style="background: #F5F5F5; padding: 5px; 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; 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;" |Seizure
+| style="background: #F5F5F5; padding: 5px; text-align:center" |↓ or '''↑'''
+| style="background: #F5F5F5; padding: 5px;" |
+| style="background: #F5F5F5; padding: 5px;" |
+| style="background: #F5F5F5; padding: 5px;" |Clinical assesment and [[EEG]] <ref name="pmid11385043">{{cite journal| author=Manford M| title=Assessment and investigation of possible epileptic seizures. | journal=J Neurol Neurosurg Psychiatry | year= 2001 | volume= 70 Suppl 2 | issue=  | pages= II3-8 | pmid=11385043 | doi= | pmc=1765557 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11385043  }}</ref>
+| style="background: #F5F5F5; padding: 5px; text-align:center" |✔
+| 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; text-align:center" |✔
+| style="background: #F5F5F5; padding: 5px;" |Previous history of seizures
+| style="background: #F5F5F5; padding: 5px;" |Confusion, apathy, irritability,
+|-
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |Hypoglycemia or hyperglycemia
+| 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; text-align:center" |✔
+| style="background: #F5F5F5; padding: 5px;" |History of [[Diabetes mellitus|diabetes]]
+| style="background: #F5F5F5; padding: 5px;" |[[Palpitation|Palpitations]], sweating, [[dizziness]]
 |}

Hemorrhagic stroke differential diagnosis: Difference between revisions

Revision as of 19:04, 16 November 2016

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