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Syncope, must be differentiated from other diseases that may cause, altered mental status, motor and or somatosensory deficits. The table below, summarizes the neurologic differential diagnosis for syncope: | |||
{| | {| | ||
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Diseases | ! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Diseases | ||
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! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Gold standard test | ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Gold standard test | ||
|- | |- | ||
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[ | ! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Subdural hematoma|Subdural hemorrhage]]<ref name="pmid216947552">{{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="pmid218073452">{{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> | ||
| align="left" style="background:#F5F5F5;" | | | align="left" style="background:#F5F5F5;" | | ||
*[[Trauma]] | *[[Trauma]] | ||
*Fall | *Fall | ||
| align="center" style="background:#F5F5F5;" | + | | align="center" style="background:#F5F5F5;" | + | ||
| align="center" style="background:#F5F5F5;" | + | | align="center" style="background:#F5F5F5;" | + | ||
| align="center" style="background:#F5F5F5;" | + | | align="center" style="background:#F5F5F5;" | + | ||
| align="center" style="background:#F5F5F5;" | + | | align="center" style="background:#F5F5F5;" | + | ||
| align="center" style="background:#F5F5F5;" | + | | align="center" style="background:#F5F5F5;" | + | ||
| align="center" style="background:#F5F5F5;" |– | | align="center" style="background:#F5F5F5;" |– | ||
| align="center" style="background:#F5F5F5;" |– | | align="center" style="background:#F5F5F5;" |– | ||
| align="center" style="background:#F5F5F5;" |– | | align="center" style="background:#F5F5F5;" |– | ||
| align="center" style="background:#F5F5F5;" | + | | align="center" style="background:#F5F5F5;" | + | ||
| align="center" style="background:#F5F5F5;" | + | | align="center" style="background:#F5F5F5;" | + | ||
| align="center" style="background:#F5F5F5;" |[[Xanthochromia]] | | align="center" style="background:#F5F5F5;" |[[Xanthochromia]] | ||
| align="center" style="background:#F5F5F5;" |CT scan without contrast | | align="center" style="background:#F5F5F5;" |CT scan without contrast | ||
Line 81: | Line 43: | ||
*[[Nausea and vomiting]] | *[[Nausea and vomiting]] | ||
|- | |- | ||
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Neurosyphilis]] | ! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Neurosyphilis]] | ||
| align="left" style="background:#F5F5F5;" | | | align="left" style="background:#F5F5F5;" | | ||
*[[Sexually transmitted disease]] | *[[Sexually transmitted disease]] | ||
| align="center" style="background:#F5F5F5;" | + | | align="center" style="background:#F5F5F5;" | + | ||
| align="center" style="background:#F5F5F5;" |– | | align="center" style="background:#F5F5F5;" |– | ||
| align="center" style="background:#F5F5F5;" | + | | align="center" style="background:#F5F5F5;" | + | ||
| align="center" style="background:#F5F5F5;" | + | | align="center" style="background:#F5F5F5;" | + | ||
| align="center" style="background:#F5F5F5;" | + | | align="center" style="background:#F5F5F5;" | + | ||
| align="center" style="background:#F5F5F5;" | + | | align="center" style="background:#F5F5F5;" | + | ||
| align="center" style="background:#F5F5F5;" |– | | align="center" style="background:#F5F5F5;" |– | ||
| align="center" style="background:#F5F5F5;" | + | | align="center" style="background:#F5F5F5;" | + | ||
| align="center" style="background:#F5F5F5;" |– | | align="center" style="background:#F5F5F5;" |– | ||
| align="center" style="background:#F5F5F5;" | + | | align="center" style="background:#F5F5F5;" | + | ||
| align="center" style="background:#F5F5F5;" |↑ [[Leukocytes]] and [[protein]] | | align="center" style="background:#F5F5F5;" |↑ [[Leukocytes]] and [[protein]] | ||
| align="center" style="background:#F5F5F5;" |Specific: CSF [[VDRL]] | | align="center" style="background:#F5F5F5;" |Specific: CSF [[VDRL]] | ||
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*[[Depression]] | *[[Depression]] | ||
*Abnormal [[gait]] | *Abnormal [[gait]] | ||
|- | |- | ||
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Hypertensive encephalopathy]] | ! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Hypertensive encephalopathy]] | ||
Line 161: | Line 104: | ||
*[[Ophthalmoplegia]] | *[[Ophthalmoplegia]] | ||
*[[Confusion]] | *[[Confusion]] | ||
|- | |- | ||
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Drug toxicity]] | ! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Drug toxicity]] | ||
| align="left" style="background:#F5F5F5;" |Medication history of | | align="left" style="background:#F5F5F5;" |Medication history of | ||
*[[Lithium]] | *[[Lithium]] | ||
*[[Sedatives]] | *[[Sedatives]] | ||
Line 189: | Line 113: | ||
*[[Carbamazepine]] | *[[Carbamazepine]] | ||
| align="center" style="background:#F5F5F5;" |– | | align="center" style="background:#F5F5F5;" |– | ||
| align="center" style="background:#F5F5F5;" | + | | align="center" style="background:#F5F5F5;" | + | ||
| align="center" style="background:#F5F5F5;" |– | | align="center" style="background:#F5F5F5;" |– | ||
| align="center" style="background:#F5F5F5;" | + | | align="center" style="background:#F5F5F5;" | + | ||
| align="center" style="background:#F5F5F5;" | + | | align="center" style="background:#F5F5F5;" | + | ||
| align="center" style="background:#F5F5F5;" | + | | align="center" style="background:#F5F5F5;" | + | ||
| align="center" style="background:#F5F5F5;" |– | | align="center" style="background:#F5F5F5;" |– | ||
| align="center" style="background:#F5F5F5;" | + | | align="center" style="background:#F5F5F5;" | + | ||
| align="center" style="background:#F5F5F5;" |– | | align="center" style="background:#F5F5F5;" |– | ||
| align="center" style="background:#F5F5F5;" |– | | align="center" style="background:#F5F5F5;" |– | ||
| align="center" style="background:#F5F5F5;" |NA | | align="center" style="background:#F5F5F5;" |NA | ||
| align="center" style="background:#F5F5F5;" |Drug screen test | | align="center" style="background:#F5F5F5;" |Drug screen test | ||
| align="center" style="background:#F5F5F5;" | | | align="center" style="background:#F5F5F5;" | | ||
* | * Confusion | ||
|- | |- | ||
! style="background: #DCDCDC; padding: 5px; text-align: center;" |Metabolic disturbances ([[electrolyte imbalance]], [[hypoglycemia]]) | ! style="background: #DCDCDC; padding: 5px; text-align: center;" |Metabolic disturbances ([[electrolyte imbalance]], [[hypoglycemia]]) | ||
Line 244: | Line 149: | ||
*[[Hypoglycemia]] | *[[Hypoglycemia]] | ||
|- | |- | ||
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Meningitis]] or [[encephalitis]] | ! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Meningitis]] or [[encephalitis]] | ||
| align="left" style="background:#F5F5F5;" | | | align="left" style="background:#F5F5F5;" | | ||
*History of [[fever]] and [[malaise]] | *History of [[fever]] and [[malaise]] | ||
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*[[Fever]] | *[[Fever]] | ||
*Neck rigidity | *Neck rigidity | ||
*[[Confusion]] | |||
|- | |- | ||
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Seizure]] | |||
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Seizure]] | |||
| align="left" style="background:#F5F5F5;" | | | align="left" style="background:#F5F5F5;" | | ||
*Previous history of [[seizures]] | *Previous history of [[seizures]] | ||
| align="center" style="background:#F5F5F5;" | + | | align="center" style="background:#F5F5F5;" | + | ||
| align="center" style="background:#F5F5F5;" | + | | align="center" style="background:#F5F5F5;" | + | ||
| align="center" style="background:#F5F5F5;" |– | | align="center" style="background:#F5F5F5;" |– | ||
| align="center" style="background:#F5F5F5;" |– | | align="center" style="background:#F5F5F5;" |– | ||
| align="center" style="background:#F5F5F5;" | + | | align="center" style="background:#F5F5F5;" | + | ||
| align="center" style="background:#F5F5F5;" | + | | align="center" style="background:#F5F5F5;" | + | ||
| align="center" style="background:#F5F5F5;" |– | | align="center" style="background:#F5F5F5;" |– | ||
| align="center" style="background:#F5F5F5;" |– | | align="center" style="background:#F5F5F5;" |– | ||
| align="center" style="background:#F5F5F5;" | + | | align="center" style="background:#F5F5F5;" | + | ||
| align="center" style="background:#F5F5F5;" |– | | align="center" style="background:#F5F5F5;" |– | ||
| align="center" style="background:#F5F5F5;" |Mass lesion | | align="center" style="background:#F5F5F5;" |Mass lesion |
Revision as of 17:32, 26 April 2020
Syncope, must be differentiated from other diseases that may cause, altered mental status, motor and or somatosensory deficits. The table below, summarizes the neurologic differential diagnosis for syncope:
Diseases | History | Symptoms | Physical Examination | Diagnostic tests | Other Findings | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Headache | ↓ LOC | Motor weakness | Abnormal sensory | Motor Deficit | Sensory deficit | Speech difficulty | Gait abnormality | Cranial nerves | CT/MRI | CSF | Gold standard test | |||
Subdural hemorrhage[1][2] |
|
+ | + | + | + | + | – | – | – | + | + | Xanthochromia | CT scan without contrast | |
Neurosyphilis | + | – | + | + | + | + | – | + | – | + | ↑ Leukocytes and protein | Specific: CSF VDRL
Sensitive: CSF FTA-Ab |
| |
Hypertensive encephalopathy | + | + | – | – | – | – | + | + | – | + | NA | Clinical assesment |
| |
Wernicke’s encephalopathy |
|
– | + | – | – | – | + | + | + | + | – | NA | Clinical assesment and lab findings | |
Drug toxicity | Medication history of | – | + | – | + | + | + | – | + | – | – | NA | Drug screen test |
|
Metabolic disturbances (electrolyte imbalance, hypoglycemia) | – | – | + | + | + | + | + | – | – | + | – | Hypoglycemia, hyponatremia, hypernatremia, hypokalemia, and hyperkalemia | Depends on the cause | |
Meningitis or encephalitis | + | – | – | – | – | + | + | – | – | – | ↑ Leukocytes, ↑ protein, ↓ glucose | CSF analysis | ||
Seizure |
|
+ | + | – | – | + | + | – | – | + | – | Mass lesion | Clinical assesment and EEG |
Common Causes of Sick sinus syndrome |
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Images
Disease Name | Age of Onset | Gender Preponderance | Signs/Symptoms | Imaging Feature(s) | Macroscopic Feature(s) | Microscopic Feature(s) | Laboratory Findings(s) | Other Feature(s) | ECG view |
---|---|---|---|---|---|---|---|---|---|
- ↑ 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.