Delirium tremens differential diagnosis: Difference between revisions
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Delirium tremens (DT) should be distinguished from [[alcoholic hallucinosis]]. Alcoholic hallucinosis (or alcohol-related psychosis) is a complication of alcohol withdrawal in alcoholics. This develops about 12 to 24 hours after drinking stops and involves auditory and visual hallucinations, most commonly accusatory or threatening voices. This condition is distinct from delirium tremens since it develops and resolves rapidly, involves a limited set of hallucinations and has no other physical symptoms. | Delirium tremens (DT) should be distinguished from [[alcoholic hallucinosis]]. Alcoholic hallucinosis (or alcohol-related psychosis) is a complication of alcohol withdrawal in alcoholics. This develops about 12 to 24 hours after drinking stops and involves auditory and visual hallucinations, most commonly accusatory or threatening voices. This condition is distinct from delirium tremens since it develops and resolves rapidly, involves a limited set of hallucinations and has no other physical symptoms. | ||
{| | |||
|-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== | ||
{{reflist|2}} | {{reflist|2}} | ||
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Delirium Tremens Microchapters |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Vishnu Vardhan Serla M.B.B.S. [2]
Differentiating Delirium Tremens from other Diseases
Delirium tremens (DT) should be distinguished from alcoholic hallucinosis. Alcoholic hallucinosis (or alcohol-related psychosis) is a complication of alcohol withdrawal in alcoholics. This develops about 12 to 24 hours after drinking stops and involves auditory and visual hallucinations, most commonly accusatory or threatening voices. This condition is distinct from delirium tremens since it develops and resolves rapidly, involves a limited set of hallucinations and has no other physical symptoms.
| 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.