Radiation injury differential diagnosis: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
(Created page with "__NOTOC__ {{Radiation injury}} Please help WikiDoc by adding content here. It's easy! Click here to learn about editing. ==References== {{Ref...")
 
No edit summary
 
Line 2: Line 2:
{{Radiation injury}}
{{Radiation injury}}


Please help WikiDoc by adding content here.  It's easy! Click [[Help:How_to_Edit_a_Page|here]]  to learn about editing.
==Differentiating Radiation injury From Other Diseases==
[[Radiation injury]] should be differentiated from other [[diseases]] causing severe [[headache]] for example: <ref>{{Cite journal
| author = [[Endrit Ziu]] & [[Fassil Mesfin]]
| title = Subarachnoid Hemorrhage
| year = 2017
| pmid = 28722987
}}</ref><ref>{{Cite journal
| author = [[Benedikt Schwermer]], [[Daniel Eschle]] & [[Constantine Bloch-Infanger]]
| title = &#91;Fever and Headache after a Vacation in Thailand&#93;
| journal = [[Deutsche medizinische Wochenschrift (1946)]]
| volume = 142
| issue = 14
| pages = 1063–1066
| year = 2017
| doi = 10.1055/s-0043-106282
| pmid = 28728201
}}</ref><ref>{{Cite journal
| author = [[Otto Rapalino]] & [[Mark E. Mullins]]
| title = Intracranial Infectious and Inflammatory Diseases Presenting as Neurosurgical Pathologies
| journal = [[Neurosurgery]]
| year = 2017
| doi = 10.1093/neuros/nyx201
| pmid = 28575459
}}</ref><ref>{{Cite journal
| author = [[I. B. Komarova]], [[V. P. Zykov]], [[L. V. Ushakova]], [[E. K. Nazarova]], [[E. B. Novikova]], [[O. V. Shuleshko]] & [[M. G. Samigulina]]
| title = &#91;Clinical and neuroimaging signs of cardioembolic stroke laboratory in children&#93;
| journal = [[Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova]]
| volume = 117
| issue = 3. Vyp. 2
| pages = 11–19
| year = 2017
| doi = 10.17116/jnevro20171173211-19
| pmid = 28665364
}}</ref><ref>{{Cite journal
| author = [[Sanjay Konakondla]], [[Clemens M. Schirmer]], [[Fengwu Li]], [[Xiaogun Geng]] & [[Yuchuan Ding]]
| title = New Developments in the Pathophysiology, Workup, and Diagnosis of Dural Venous Sinus Thrombosis (DVST) and a Systematic Review of Endovascular Treatments
| journal = [[Aging and disease]]
| volume = 8
| issue = 2
| pages = 136–148
  | year = 2017
| doi = 10.14336/AD.2016.0915
  | pmid = 28400981
}}</ref><ref>{{Cite journal
  | author = [[Priyanka Yadav]], [[Alec L. Bradley]] & [[Jonathan H. Smith]]
| title = Recognition of Chronic Migraine by Medicine Trainees: A Cross-Sectional Survey
| journal = [[Headache]]
| year = 2017
| doi = 10.1111/head.13133
| pmid = 28653369
}}</ref><ref>{{Cite journal
| author = [[S. Wulffeld]], [[L. S. Rasmussen]], [[B. Hojlund Bech]] & [[J. Steinmetz]]
| title = The effect of CT scanners in the trauma room - an observational study
| journal = [[Acta anaesthesiologica Scandinavica]]
| volume = 61
| issue = 7
| pages = 832–840
| year = 2017
  | doi = 10.1111/aas.12927
| pmid = 28635146
}}</ref><ref>{{cite journal |vauthors=Johnston PC, Chew LS, Hamrahian AH, Kennedy L |title=Lymphocytic infundibulo-neurohypophysitis: a clinical overview |journal=Endocrine |volume=50 |issue=3 |pages=531–6 |year=2015 |pmid=26219407 |doi=10.1007/s12020-015-0707-6 |url=}}</ref><ref>{{cite journal |vauthors=Makale MT, McDonald CR, Hattangadi-Gluth JA, Kesari S |title=Mechanisms of radiotherapy-associated cognitive disability in patients with brain tumours |journal=Nat Rev Neurol |volume=13 |issue=1 |pages=52–64 |year=2017 |pmid=27982041 |doi=10.1038/nrneurol.2016.185 |url=}}</ref><ref name="pmid9541295">{{cite journal| author=Sato N, Sze G, Endo K| title=Hypophysitis: endocrinologic and dynamic MR findings. | journal=AJNR Am J Neuroradiol | year= 1998 | volume= 19 | issue= 3 | pages= 439-44 | pmid=9541295 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9541295  }} </ref>


{| class="wikitable"
! rowspan="3" |Disease
! colspan="3" |Symptoms
! rowspan="3" |Gold Standard
! rowspan="3" |CT/MRI
! rowspan="3" |Other Investigation Findings
|-
! colspan="2" |'''Headache'''
! rowspan="2" |Other features
|-
!Onset
!Characteristics
|-
|Pituitary apoplexy
|Sudden
|Severe [[headache]]
|
* [[Nausea and vomiting]]
* Paralysis of eye muscles ([[diplopia]])
* Changes in vision
|MRI
|
* [[CT]] scan without [[Contrast medium|contrast]] is the initial test of choice. Pituitary hemorrhage on [[CT]] presents as a hyper-dense lesion.
* [[MRI]] is done in cases of inconclusive [[CT]]. An [[MRI]] is more sensitive in identifying [[intrasellar]] mass and soft tissue changes.
|[[Blood tests]] may be done to check:
* PT/INR and aPTT
* Pituitary hormonal assay
|-
|[[Subarachnoid hemorrhage]]
|Sudden
|
* [[Headache|Severe headache]]
* <nowiki/>[[Thunderclap headache|Thunderclap]]
* Described as the worst headache of life
|
* [[Double vision]]
* [[Nausea]] and [[vomiting]]
* Symptoms of [[meningeal irritation]]
* Sudden [[Loss of consciousness|decreased level of consciousness]]
|[[Digital subtraction angiography]]
|
* The modality of choice for diagnosis of [[subarachnoid hemorrhage]] is noncontrast head [[Computed tomography|computed tomography (CT)]], with or without [[lumbar puncture]].<sup>[[Subarachnoid hemorrhage CT#cite note-pmid7897421-1|[1]]]</sup>
* [[Computed tomography|CT]] shows hyperattenuating material filling the subarachnoid space.
|
* [[Lumbar puncture|Lumbar puncture (LP)]] is necessary when there is a strong suspicion of [[subarachnoid hemorrhage]]. LP will show:
** Elevated opening pressure
** Elevated [[Red blood cell|red blood cell (RBC)]]
** [[Xanthochromic|Xanthochromia]]
|-
|[[Meningitis]]
|Sudden
|[[Headache]] is associated with:
* [[Fever]]
* [[Neck stiffness]]
|
* [[Photophobia]]   
* [[Phonophobia]] 
* [[Irritability]]
* [[Altered mental status]]
|[[Lumbar puncture]] for [[CSF]]
|
* [[CT]] scan of the head may be performed before [[Lumbar puncture|LP]] to determine the risk of [[herniation]].
|
* Diagnosis is based on clinical presentation in combination with [[CSF]] analysis.
* [[CSF]] analysis is the investigation of choice.
* For more information on [[CSF]] analysis in meningitis please [[Meningitis#Diagnosis|click here.]]
|-
|[[Intracranial mass]]
|Gradual
|[[Morning headache]]
|
* [[Nausea]]
* [[Vomiting]]
* [[Change in mental status]]
* [[Seizures]]
* Focal neurological deficits
|[[MRI]]
|
* [[CT]] or [[MRI]] is the initial test to detect intracranial lesions (ring enhancing lesions).
* These imaging tests determine the location of [[intracranial mass]] lesion(s) and help in guiding [[therapy]].
|
* [[Biopsy]] of the lesion may be done to identify the nature of the lesion such as:
** [[Tumor]]
** [[Abscess]]
* X-ray of the skull is a non specific test, but useful if any of the lesions are [[Calcified lesion|calcified]]
|-
|[[Cerebral hemorrhage]]
|Sudden
|Rapidly progressing headache
|
* Symptoms of [[increased intracranial pressure]] (ICP)
* Focal neurological deficits
|[[CT]] without [[Contrast medium|contrast]]
(differentiate [[ischemic stroke]] from [[hemorrhagic stroke|hemorrhagic stroke]])
|
* [[CT]] is very sensitive for identifying acute [[hemorrhage]] which appears as a hyperattenuating clot.
* Gradient echo and T2 susceptibility-weighted [[MRI]] are as sensitive as [[CT]] for detection of acute hemorrhage and are more sensitive for identification of prior hemorrhage.
|
* [[PT]]/[[INR]] and [[aPTT]] should be checked to rule out [[coagulopathy]].
|-
|[[Intracranial venous thrombosis]]
|Gradual
|
* Diffuse [[headache]]
* [[Headache]] can be the only symptom of [[Cerebral venous sinus thrombosis|cerebral venous thrombosis]]
|
* Focal neurological deficits
* [[Seizure|Seizures]]
* [[Coma|Depressed level of consciousness]] 
|[[Digital subtraction angiography]]
|
* The classic finding of sinus thrombosis on unenhanced [[CT]] images is a hyperattenuating thrombus in the occluded sinus.
* [[CT]] and [[MRI]] may identify [[Cerebral edema]] and venous [[infarction]] may be apparent.
|
* CT [[venography]] detects the [[thrombus]], [[computed tomography]] with [[radiocontrast]] in the venous phase (CT venography or CTV) has a detection rate that in some regards exceeds that of [[MRI]].
* [[Cerebral angiography]] may demonstrate smaller clots, and obstructed veins may give the "corkscrew appearance."
|-
|[[Migraine]]
|Sudden
|
* Severe to moderate [[headache]]
* One-sided
* Pulsating
* Lasts between several hours to three days.
|
* [[Nausea and vomiting]]
* Preceding [[Aura (symptom)|aura]]
* [[Photophobia]]
* [[Phonophobia]]
|'''---'''
|
* [[CT]] and [[MRI]] may be needed to rule out other suspected possible causes of [[headache]].
|
* [[Migraine]] is a clinical [[diagnosis]] that does not require any laboratory tests.
* Laboratory tests may be ordered to rule out any suspected coexistent metabolic problems.
|-
|[[Head injury]]
|Sudden
|
* Dull
* Throbbing
* One sided or all around
|
* [[Confusion]]
* [[Drowsiness]]
* Personality change
* [[Seizure|Seizures]]
* [[Nausea]] and [[vomiting]]
* [[Headache|Loss of consciousness]]
* [[Lucid interval]]
|[[CT]] scan without contrast
|
* [[CT]] scan is the first test performed and identifies [[cerebral hemorrhage]] (appears as a hyperattenuating clot) following head injury.
* [[MRI]] is more sensitive, takes more time, and is done in patients with symptoms unexplained by [[Computed tomography|CT]] scan.
|
* The [[Glasgow Coma Scale]] is a tool for measuring degree of unconsciousness and is a useful tool for determining severity of injury.
* The [[Pediatric Glasgow Coma Scale]] is used in young children.
|-
|[[Lymphocytic hypophysitis]]
|Sudden
|
* Generalized
* Retro-orbital or Bitemporal
|
* Most often seen in late pregnancy or the [[postpartum]] period
* Mass lesion effect such as [[Visual field defect|visual field defects]]
* [[Hypopituitarism]]
|Pituitary biopsy
|[[CT]] & [[MRI]] typically reveal features of a pituitary mass.
|The most accurate test is a pituitary [[biopsy]] which will show [[lymphocytic]] [[Infiltration (medical)|infiltration]].
|}
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}


{{reflist|2}}
[[Category:Needs content]]
[[Category:Emergency medicine]]
[[Category:Emergency medicine]]
[[Category:Dermatology]]
[[Category:Endocrinology]]
[[Category:Cardiology]]
[[Category:Neurology]]
[[Category:Radiology]]
[[Category:Obstetrics]]
[[Category:Needs overview]]
[[Category:Disease]]
[[Category:Needs content]]


{{WH}}
{{WH}}
{{WS}}
{{WS}}

Latest revision as of 20:03, 2 August 2017

Radiation injury Microchapters

Home

Patient Information

Overview

Classification

Pathophysiology

Causes

Differentiating Radiation injury from other Diseases

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Radiation injury differential diagnosis On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Radiation injury differential diagnosis

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Radiation injury differential diagnosis

CDC on Radiation injury differential diagnosis

Radiation injury differential diagnosis in the news

Blogs on Radiation injury differential diagnosis

Directions to Hospitals Treating Radiation injury

Risk calculators and risk factors for Radiation injury differential diagnosis

Differentiating Radiation injury From Other Diseases

Radiation injury should be differentiated from other diseases causing severe headache for example: [1][2][3][4][5][6][7][8][9][10]

Disease Symptoms Gold Standard CT/MRI Other Investigation Findings
Headache Other features
Onset Characteristics
Pituitary apoplexy Sudden Severe headache MRI
  • CT scan without contrast is the initial test of choice. Pituitary hemorrhage on CT presents as a hyper-dense lesion.
  • MRI is done in cases of inconclusive CT. An MRI is more sensitive in identifying intrasellar mass and soft tissue changes.
 Blood tests may be done to check:
  • PT/INR and aPTT
  • Pituitary hormonal assay
Subarachnoid hemorrhage Sudden Digital subtraction angiography
Meningitis Sudden Headache is associated with: Lumbar puncture for CSF
  • CT scan of the head may be performed before LP to determine the risk of herniation.
  • Diagnosis is based on clinical presentation in combination with CSF analysis.
  • CSF analysis is the investigation of choice.
  • For more information on CSF analysis in meningitis please click here.
Intracranial mass Gradual Morning headache MRI
  • CT or MRI is the initial test to detect intracranial lesions (ring enhancing lesions).
  • These imaging tests determine the location of intracranial mass lesion(s) and help in guiding therapy.
  • Biopsy of the lesion may be done to identify the nature of the lesion such as:
  • X-ray of the skull is a non specific test, but useful if any of the lesions are calcified
Cerebral hemorrhage Sudden Rapidly progressing headache
  • Focal neurological deficits
 CT without contrast

(differentiate ischemic stroke from hemorrhagic stroke)

  • CT is very sensitive for identifying acute hemorrhage which appears as a hyperattenuating clot.
  • Gradient echo and T2 susceptibility-weighted MRI are as sensitive as CT for detection of acute hemorrhage and are more sensitive for identification of prior hemorrhage.
Intracranial venous thrombosis Gradual Digital subtraction angiography
  • The classic finding of sinus thrombosis on unenhanced CT images is a hyperattenuating thrombus in the occluded sinus.
  • Cerebral angiography may demonstrate smaller clots, and obstructed veins may give the "corkscrew appearance."
Migraine Sudden
  • Severe to moderate headache
  • One-sided
  • Pulsating
  • Lasts between several hours to three days.
 ---
  • CT and MRI may be needed to rule out other suspected possible causes of headache.
  • Migraine is a clinical diagnosis that does not require any laboratory tests.
  • Laboratory tests may be ordered to rule out any suspected coexistent metabolic problems.
Head injury Sudden
  • Dull
  • Throbbing
  • One sided or all around
 CT scan without contrast
  • CT scan is the first test performed and identifies cerebral hemorrhage (appears as a hyperattenuating clot) following head injury.
  • MRI is more sensitive, takes more time, and is done in patients with symptoms unexplained by CT scan.
Lymphocytic hypophysitis Sudden
  • Generalized
  • Retro-orbital or Bitemporal
  • Most often seen in late pregnancy or the postpartum period
 Pituitary biopsy CT & MRI typically reveal features of a pituitary mass. The most accurate test is a pituitary biopsy which will show lymphocytic infiltration.

References

  1. ↑ Endrit Ziu & Fassil Mesfin (2017). "Subarachnoid Hemorrhage". PMID 28722987.
  2. ↑ Benedikt Schwermer, Daniel Eschle & Constantine Bloch-Infanger (2017). "[Fever and Headache after a Vacation in Thailand]". Deutsche medizinische Wochenschrift (1946). 142 (14): 1063–1066. doi:10.1055/s-0043-106282. PMID 28728201.
  3. ↑ Otto Rapalino & Mark E. Mullins (2017). "Intracranial Infectious and Inflammatory Diseases Presenting as Neurosurgical Pathologies". Neurosurgery. doi:10.1093/neuros/nyx201. PMID 28575459.
  4. ↑ I. B. Komarova, V. P. Zykov, L. V. Ushakova, E. K. Nazarova, E. B. Novikova, O. V. Shuleshko & M. G. Samigulina (2017). "[Clinical and neuroimaging signs of cardioembolic stroke laboratory in children]". Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova. 117 (3. Vyp. 2): 11–19. doi:10.17116/jnevro20171173211-19. PMID 28665364.
  5. ↑ Sanjay Konakondla, Clemens M. Schirmer, Fengwu Li, Xiaogun Geng & Yuchuan Ding (2017). "New Developments in the Pathophysiology, Workup, and Diagnosis of Dural Venous Sinus Thrombosis (DVST) and a Systematic Review of Endovascular Treatments". Aging and disease. 8 (2): 136–148. doi:10.14336/AD.2016.0915. PMID 28400981.
  6. ↑ Priyanka Yadav, Alec L. Bradley & Jonathan H. Smith (2017). "Recognition of Chronic Migraine by Medicine Trainees: A Cross-Sectional Survey". Headache. doi:10.1111/head.13133. PMID 28653369.
  7. ↑ S. Wulffeld, L. S. Rasmussen, B. Hojlund Bech & J. Steinmetz (2017). "The effect of CT scanners in the trauma room - an observational study". Acta anaesthesiologica Scandinavica. 61 (7): 832–840. doi:10.1111/aas.12927. PMID 28635146.
  8. ↑ Johnston PC, Chew LS, Hamrahian AH, Kennedy L (2015). "Lymphocytic infundibulo-neurohypophysitis: a clinical overview". Endocrine. 50 (3): 531–6. doi:10.1007/s12020-015-0707-6. PMID 26219407.
  9. ↑ Makale MT, McDonald CR, Hattangadi-Gluth JA, Kesari S (2017). "Mechanisms of radiotherapy-associated cognitive disability in patients with brain tumours". Nat Rev Neurol. 13 (1): 52–64. doi:10.1038/nrneurol.2016.185. PMID 27982041.
  10. ↑ Sato N, Sze G, Endo K (1998). "Hypophysitis: endocrinologic and dynamic MR findings". AJNR Am J Neuroradiol. 19 (3): 439–44. PMID 9541295.

Template:WH Template:WS

Retrieved from "https://www.wikidoc.org/index.php?title=Radiation_injury_differential_diagnosis&oldid=1334412"