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| ==Differential diagnosis== | | ==Differential diagnosis== |
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| == hhh==
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| {|
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| |- style="background: #4479BA; color: #FFFFFF; text-align: center;"
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| ! rowspan="2" |<small>Diseases</small>
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| ! colspan="5" |<small>History and Physical
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| ! colspan="2" |<small>Diagnostic tests</small>
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| ! rowspan="2" |<small>Other Findings</small>
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| |- style="background: #4479BA; color: #FFFFFF; text-align: center;"
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| !Prodromal symptoms
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| !<small>Fever</small>
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| !<small>Headache</small>
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| !<small>LOC</small>
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| !<small>Neuro Onset</small>
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| !<small>Laboratory Findings</small>
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| !<small>Imaging</small>
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| |-
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| ! style="background: #DCDCDC; padding: 5px; text-align:center;" |Rabies infection
| |
| | 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" | +
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| | style="background: #F5F5F5; padding: 5px; text-align:center" |Insidious
| |
| | style="background: #F5F5F5; padding: 5px; text-align:center" |
| |
| | style="background: #F5F5F5; padding: 5px; text-align:center" |
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| | style="background: #F5F5F5; padding: 5px; text-align:center" |Hydrophobia, aerophobia, dysphagia, and localized pain, weakness or paresthesias
| |
| |-
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| ! style="background: #DCDCDC; padding: 5px; text-align:center;" |[[Meningitis]]
| |
| | 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" |Sudden
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| | style="background: #F5F5F5; padding: 5px; text-align:center" | CSF analysis:
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| * '''↑''' Leukocytes
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| * '''↑''' Protein
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| * ↓ Glucose
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| | style="background: #F5F5F5; padding: 5px; text-align:center" |
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| | style="background: #F5F5F5; padding: 5px; text-align:center" |[[Fever]], [[Neck rigidity|neck]], [[Neck rigidity|rigidity]]
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| |-
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| ! style="background: #DCDCDC; padding: 5px; text-align:center;" |[[encephalitis]]
| |
| | 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" |
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| | style="background: #F5F5F5; padding: 5px; text-align:center" |Accompany a meningoencephalitis, seizures, hemiparesis, cranial nerve palsies, photophobia, nausea
| |
| |-
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| ! style="background: #DCDCDC; padding: 5px; text-align:center;" |Autoimmune encephalitis
| |
| | 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" |Insidious
| |
| | style="background: #F5F5F5; padding: 5px; text-align:center" |
| |
| | style="background: #F5F5F5; padding: 5px; text-align:center" |
| |
| | style="background: #F5F5F5; padding: 5px; text-align:center" |Memory deficit, dyskinesias, seizures, autonomic instability
| |
| |-
| |
| ! style="background: #DCDCDC; padding: 5px; text-align:center;" |[[Brain abscess|CNS abscess]]
| |
| | 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" |Insidious
| |
| | style="background: #F5F5F5; padding: 5px; text-align:center" |CSF analysis:
| |
| * '''↑''' leukocytes
| |
| * '''↓''' glucose
| |
| * '''↑''' protien
| |
| | style="background: #F5F5F5; padding: 5px; text-align:center" |MRI is more sensitive and specific
| |
| | style="background: #F5F5F5; padding: 5px; text-align:center" |High grade [[fever]], [[fatigue]],[[nausea]], [[vomiting]]
| |
| |-
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| ! style="background: #DCDCDC; padding: 5px; text-align:center;" | [[Poliomyelitis]]
| |
| | 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" |Sudden
| |
| | style="background: #F5F5F5; padding: 5px; text-align:center" |PCR of CSF
| |
| | style="background: #F5F5F5; padding: 5px; text-align:center" |
| |
| | style="background: #F5F5F5; padding: 5px; text-align:center" |Asymmetric paralysis following a flu-like syndrome.
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| |-
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| ! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Neurosyphilis]]
| |
| | 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" |Insidious<nowiki/>
| |
| | style="background: #F5F5F5; padding: 5px; text-align:center" |CSF [[VDRL]]-specifc
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| CSF [[FTA-ABS|FTA-Ab]] -sensitive
| |
| | style="background: #F5F5F5; padding: 5px; text-align:center" |MRI & [[Lumbar puncture]]
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| | style="background: #F5F5F5; padding: 5px; text-align:center" |History of unprotected sex or multiple sexual partners, and [[genital ulcer]] ([[chancre]])
| |
| [[Blindness]], [[confusion]], [[depression]], abnormal [[gait]]
| |
| |-
| |
| ! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Tick paralysis]] ([[Dermacentor andersoni|Dermacentor tick]])
| |
| | 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" |Insidious
| |
| | style="background: #F5F5F5; padding: 5px; text-align:center" | -
| |
| | style="background: #F5F5F5; padding: 5px; text-align:center" | -
| |
| | style="background: #F5F5F5; padding: 5px; text-align:center" |History of outdoor activity in Northeastern United States. The tick is often still latched to the patient at presentation (often in head and neck area)
| |
| |-
| |
| ! style="background: #DCDCDC; padding: 5px; text-align: center;" | Adult Botulism
| |
| | 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" |Sudden
| |
| | style="background: #F5F5F5; padding: 5px; text-align:center" |Toxin test, Blood, Wound, or Stool culture
| |
| | style="background: #F5F5F5; padding: 5px; text-align:center" |
| |
| | style="background: #F5F5F5; padding: 5px; text-align:center" |[[Diplopia]], [[Hyporeflexia|Hyporeflexia,]] [[Hypotonia]], possible respiratory paralysis, [[Floppy baby syndrome]]
| |
| |-
| |
| ! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Electrolyte disturbance]]
| |
| | 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" |Insidious
| |
| | style="background: #F5F5F5; padding: 5px; text-align:center" | Electrolyte panel:
| |
| ↓Ca++, ↓Mg++, ↓K+
| |
| | style="background: #F5F5F5; padding: 5px; text-align:center" |
| |
| | style="background: #F5F5F5; padding: 5px; text-align:center" |Possible [[arrhythmia]]
| |
| |-
| |
| ! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Tetrodotoxin]] poisoning
| |
| | 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" |Sudden
| |
| | style="background: #F5F5F5; padding: 5px; text-align:center" | -
| |
| | style="background: #F5F5F5; padding: 5px; text-align:center" | -
| |
| | style="background: #F5F5F5; padding: 5px; text-align:center" | History of consumption of puffer fish species.
| |
| |-
| |
| ! style="background: #DCDCDC; padding: 5px; text-align: center;" |Metabolic disturbances ([[electrolyte imbalance]], [[hypoglycemia]])
| |
| | 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" |Sudden
| |
| | style="background: #F5F5F5; padding: 5px; text-align:center" |[[Hypoglycemia]], [[Hyponatremia|hypo]] and [[hypernatremia]], [[Hypokalemia|hypo]] and [[hyperkalemia]]
| |
| | style="background: #F5F5F5; padding: 5px; text-align:center" |
| |
| | style="background: #F5F5F5; padding: 5px; text-align:center" |[[Confusion]], [[seizure]], [[Palpitation|palpitations]], [[sweating]], [[dizziness]], [[hypoglycemia]]
| |
| |-
| |
| ! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Drug toxicity]]/Neuroleptic malignant syndrome
| |
| | 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" |Causative medications (eg, neuroleptics, antiemetics, concomitant lithium), dopaminergic withdrawal, elevated creatine kinase
| |
| |-
| |
| ! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Organophosphate poisoning|Organophosphate toxicity]]
| |
| | 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" |Sudden
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| | style="background: #F5F5F5; padding: 5px; text-align:center" | Clinical suspicion confirmed with RBC AchE activity
| |
| | style="background: #F5F5F5; padding: 5px; text-align:center" |
| |
| | style="background: #F5F5F5; padding: 5px; text-align:center" |History of exposure to i[[Insecticide|nsecticide]] or living in farming environment. with : [[Diarrhea]], [[Urination]], [[Miosis]], [[Bradycardia]], [[Lacrimation]], [[Emesis]], [[Salivation]], [[Sweating]]
| |
| |-
| |
| ! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Stroke|Ischemic 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" |
| |
| | style="background: #F5F5F5; padding: 5px; text-align:center" |
| |
| | style="background: #F5F5F5; padding: 5px; text-align:center" |Sudden
| |
| | style="background: #F5F5F5; padding: 5px; text-align:center" |
| |
| | style="background: #F5F5F5; padding: 5px; text-align:center" |MRI +ve for ischemia or hemorrhage
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| | style="background: #F5F5F5; padding: 5px; text-align:center" |Sudden unilateral motor and sensory deficit in a patient with a history of [[Atherosclerosis|atherosclero]]<nowiki/>tic risk factors (diabetes, hypertension, smoking) or [[Atrial fibrillation|atrial fibrillation.]]
| |
| |-
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| ! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Hemorrhagic 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" | +
| |
| | style="background: #F5F5F5; padding: 5px; text-align:center" | +
| |
| | style="background: #F5F5F5; padding: 5px; text-align:center" |Sudden
| |
| | style="background: #F5F5F5; padding: 5px; text-align:center" | -
| |
| | style="background: #F5F5F5; padding: 5px; text-align:center" |CT scan without contrast
| |
| | style="background: #F5F5F5; padding: 5px; text-align:center" |[[Neck stiffness]]
| |
| |-
| |
| ! style="background: #DCDCDC; padding: 5px; text-align:center;" |[[Subdural hematoma|Subdural hemorrhage]]
| |
| | 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" |Sudden
| |
| | style="background: #F5F5F5; padding: 5px; text-align:center" |CSF analysis:
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| * Xanthochromia
| |
| | style="background: #F5F5F5; padding: 5px; text-align:center" |CT scan without contrast<ref name="pmid21694755" /><ref name="pmid21807345" />
| |
| | style="background: #F5F5F5; padding: 5px; text-align:center" |[[Confusion]], [[dizziness]], [[nausea]], [[vomiting]]
| |
| |-
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| ! style="background: #DCDCDC; padding: 5px; text-align:center;" |[[Hypertensive encephalopathy]]
| |
| | 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" |Sudden
| |
| | style="background: #F5F5F5; padding: 5px; text-align:center" |
| |
| | style="background: #F5F5F5; padding: 5px; text-align:center" | -
| |
| | style="background: #F5F5F5; padding: 5px; text-align:center" |[[Delirium]], [[cortical blindness]], [[cerebral edema]], [[seizure]]
| |
| |-
| |
| ! style="background: #DCDCDC; padding: 5px; text-align:center;" |[[Wernicke's encephalopathy|Wernicke’s encephalopathy]]
| |
| | 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" |Sudden
| |
| | style="background: #F5F5F5; padding: 5px; text-align:center" |
| |
| | style="background: #F5F5F5; padding: 5px; text-align:center" | -
| |
| | style="background: #F5F5F5; padding: 5px; text-align:center" |[[Ophthalmoplegia]], [[confusion]]
| |
| |-
| |
| ! style="background: #DCDCDC; padding: 5px; text-align: center;" | [[Guillian-Barre syndrome]]
| |
| | 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" |Insidious
| |
| | style="background: #F5F5F5; padding: 5px; text-align:center" |CSF: ↑Protein
| |
|
| |
| ↓Cells
| |
|
| |
| | style="background: #F5F5F5; padding: 5px; text-align:center" | -
| |
| | style="background: #F5F5F5; padding: 5px; text-align:center" |Progressive [[ascending paralysis]] following infection, possible respiratory paralysis
| |
| |-
| |
| ! style="background: #DCDCDC; padding: 5px; text-align:center" |[[Amyotrophic lateral sclerosis]]
| |
| | 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" |Insidious
| |
| | style="background: #F5F5F5; padding: 5px; text-align:center" | Normal [[Lumbar puncture|LP]] (to rule out DDx)
| |
| | style="background: #F5F5F5; padding: 5px; text-align:center" |MRI
| |
| | style="background: #F5F5F5; padding: 5px; text-align:center" |Patient initially presents with [[upper motor neuron]] deficit ([[spasticity]]) followed by [[lower motor neuron]] deficit ([[flaccidity]]).
| |
| |-
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| ! style="background: #DCDCDC; padding: 5px; text-align:center;" |Diffuse glioma
| |
| | 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" |Insidious
| |
| | style="background: #F5F5F5; padding: 5px; text-align:center" |GFAP
| |
| Normal CSF
| |
| | style="background: #F5F5F5; padding: 5px; text-align:center" |MRI (expansile, T2 hyperintense lesion)
| |
| | style="background: #F5F5F5; padding: 5px; text-align:center" |
| |
| |-
| |
| ! style="background: #DCDCDC; padding: 5px; text-align:center;" |Primary or secondary central nervous system lymphoma
| |
| | 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" |Insidious
| |
| | style="background: #F5F5F5; padding: 5px; text-align:center" |CSF cytology, flow cytometry, and stereotactic brain biopsy
| |
| | style="background: #F5F5F5; padding: 5px; text-align:center" |MRI (parenchymal or leptomeningeal enhancement)
| |
| | style="background: #F5F5F5; padding: 5px; text-align:center" |
| |
| |-
| |
| |}
| |
|
| |
| {{Reflist|2}}
| |
| <references />
| |