Fungal meningitis differential diagnosis: Difference between revisions

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Revision as of 21:23, 13 February 2017

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rim Halaby; Prince Tano Djan, BSc, MBChB [2]

Overview

The differential diagnosis of fungal meningitis includes a range of medical conditions that can be broadly classified into infectious and non infectious. The cerebrospinal fluid analysis and radiological findings help distinguishing fungal meningitis from other etiologies.

Differential Diagnosis

Meningeal infection
- Bacterial meningeal infection
- Protozoal meningeal infection
- Helminthic meningeal infection
- Viral meningeal infection
Parameningeal infection
Non infectious causes
- Behçet's syndrome
- Chronic benign lymphocytic meningitis
- Chemical meningitis
- Drug hypersensitivity
- Isolated granulomatous angiitis of the nervous system
- Granulomatosis with polyangiitis (Wegener's)
- Malignancy
- Mollaret's meningitis
- Sarcoidosis
- Systemic lupus erythematosus
- Vogt-Koyanagi-Harada syndrome^[1]

Differentiating fungal meningitis from other diseases

Diseases	Diagnostic tests				Physical Examination					Symptoms			Past medical history	Other Findings
Diseases	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	Past medical history	Other Findings
Brain tumour^[2]^[3]		✔	Cancer cells^[4]	MRI		✔	✔	✔	✔	✔		✔		Cachexia, gradual progression of symptoms
Delerium Tremens		✔		Clinical diagnosis		✔	✔		✔	✔	✔	✔	Alcohal intake, sudden witdrawl or reduction in consumption	Tachycardia, diaphoresis, hypertension, tremors, mydriasis, positional nystagmus, tachypnea
Subarachnoid hemorrhage^[5]		✔	Xanthochromia^[6]	CT scan without contrast^[7]^[8]	✔	✔	✔	✔	✔	✔	✔	✔	Trauma/fall	Confusion, dizziness, nausea, vomiting
Stroke		✔	Normal	CT scan without contrast		✔	✔		✔	✔		✔	TIAs, hypertension, diabetes mellitus	Speech difficulty, gait abnormality
Neurosyphilis^[9]^[10]		✔	↑ Leukocytes and protein	CSF VDRL-specifc CSF FTA-Ab -sensitive^[11]	✔	✔	✔	✔		✔		✔	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 seizures			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 HbA1c		✔				✔		✔	History of diabetes	Palpitations, sweating, dizziness, low serum, glucose

References

↑ Koroshetz WJ. Chapter 382. Chronic and Recurrent Meningitis. In: Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson JL, Loscalzo J, eds. Harrison's Principles of Internal Medicine. 18th ed. New York: McGraw-Hill; 2012.
↑ 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.

Template:WH Template:WS

[1] Koroshetz WJ. Chapter 382. Chronic and Recurrent Meningitis. In: Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson JL, Loscalzo J, eds. Harrison's Principles of Internal Medicine. 18th ed. New York: McGraw-Hill; 2012.

[pmid1278192-2] Soffer D (1976) Brain tumors simulating purulent meningitis. Eur Neurol 14 (3):192-7. PMID: 1278192

[pmid3883130-3] ↑

[pmid21371327-4] 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.

[pmid14585453-5] 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

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

[pmid21694755-7] Birenbaum D, Bancroft LW, Felsberg GJ (2011). "Imaging in acute stroke". West J Emerg Med. 12 (1): 67–76. PMC 3088377. PMID 21694755.

[pmid21807345-8] 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.

[pmid22482824-9] 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.

[pmid24365430-10] Berger JR, Dean D (2014). "Neurosyphilis". Handb Clin Neurol. 121: 1461–72. doi:10.1016/B978-0-7020-4088-7.00098-5. PMID 24365430.

[pmid22421697-11] 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.

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@@ Line 23: / Line 23: @@
 **[[Systemic lupus erythematosus]]
 **[[Vogt-Koyanagi-Harada syndrome]]<ref>Koroshetz WJ. Chapter 382. Chronic and Recurrent Meningitis. In: Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson JL, Loscalzo J,  eds. Harrison's Principles of Internal Medicine. 18th ed. New York: McGraw-Hill; 2012.</ref>
+===Differentiating fungal meningitis from other diseases===
+{|
+|-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;" |Delerium 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;" |Alcohal intake, sudden witdrawl or reduction in consumption
+|style="background: #F5F5F5; padding: 5px;" |Tachycardia, diaphoresis, hypertension, tremors, mydriasis, positional nystagmus, tachypnea
+|-
+|style="background: #DCDCDC; padding: 5px; text-align: center;" | 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, 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, STIs
+|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 RBCS or xanthochromia, 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, 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, seizures
+|-
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |Febrile seizures
+| 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==
@@ Line 28: / Line 302: @@
 {{WH}}
 {{WS}}
-[[Category:Infectious diseases]]
-[[Category:Fungi]]
-[[Category:Neurology]]
-[[Category:Disease]]