Acute disseminated encephalomyelitis differential diagnosis: Difference between revisions

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|'''Viral encephalitis''' <ref name="pmid14978145">{{cite journal| author=Kennedy PG| title=Viral encephalitis: causes, differential diagnosis, and management. | journal=J Neurol Neurosurg Psychiatry | year= 2004 | volume= 75 Suppl 1 | issue=  | pages= i10-5 | pmid=14978145 | doi=10.1136/jnnp.2003.034280 | pmc=1765650 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14978145  }}</ref>
|'''Viral encephalitis''' <ref name="pmid14978145">{{cite journal| author=Kennedy PG| title=Viral encephalitis: causes, differential diagnosis, and management. | journal=J Neurol Neurosurg Psychiatry | year= 2004 | volume= 75 Suppl 1 | issue=  | pages= i10-5 | pmid=14978145 | doi=10.1136/jnnp.2003.034280 | pmc=1765650 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14978145  }}</ref>
|Can occur in any age characterised by <nowiki>[[fever]]</nowiki> and occasional prodromal illness
|Can occur in any age characterised by fever and occasional prodromal illness
|Leukocytosis in blood; T2-weighted MRI shows multiple diffuse hyperintensities overlying the grey matter and white matter of bilateral cerebral cortices, and to a lesser extent the white matter, basal ganglia, brainstem and cerebellum; lymphocytic pleocytosis with elevated protein and normal glucose in CSF.
|Leukocytosis in blood; T2-weighted MRI shows multiple diffuse hyperintensities overlying the grey matter and white matter of bilateral cerebral cortices, and to a lesser extent the white matter, basal ganglia, brainstem and cerebellum; lymphocytic pleocytosis with elevated protein and normal glucose in CSF.
|CSF analysis for viral cultures and serological assays
|CSF analysis for viral cultures and serological assays

Revision as of 11:36, 10 November 2022

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sujaya Chattopadhyay, M.D.[2]

Overview

Differential Diagnosis

Disease Clinical manifestations Para-clinical findings Gold standard Additional findings
Viral encephalitis [1] Can occur in any age characterised by fever and occasional prodromal illness Leukocytosis in blood; T2-weighted MRI shows multiple diffuse hyperintensities overlying the grey matter and white matter of bilateral cerebral cortices, and to a lesser extent the white matter, basal ganglia, brainstem and cerebellum; lymphocytic pleocytosis with elevated protein and normal glucose in CSF. CSF analysis for viral cultures and serological assays History of recent travel, animal bites (lyme disease/rabies), contact with childhood exanthema and polio, high-risk occupations and drug abuse; skin rashes (VZV,Measles, Rickettsia). HSV may cause fronto-temporal signs, aphasia, personality changes and focal seizures while myelitis is seen in polio infection.
HIV encephalopathy[2] Waxing and waning pattern of psychomotor retardation, decreased memory, concentration and attention span. Tremor, ataxia, hyperreflexia, hypertonia, progressive decline in MMSE scores[3]. Typical absence of cortical signs and symptoms Increase in CSF protein, cell count; multiple symmetric, hyperintense, non-enhancing subcortical foci on T2-weighted MRI[4]. Identification of HIV RNA in CSF Bowel and/or bladder complaints
Multiple sclerosis Sensory disturbances, walking difficulties, dizziness, vision problems, intestinal, urinary and sexual dysfunction, cognitive and emotional impairment[5] MRI of the brain and spinal cord showing new lesions, both enhancing and non-enhancing, disseminated in space and time[6]; evoked potentials test demonstrate demyelination in the optic nerve and CNS[7]; Myelin basic protein and IgG oligoclonal bands on CSF analysis[8]; vitamin deficiencies in blood sample[9]. T2-weighted MRI of the brain and spinal cord showing new patchy lesions, both enhancing and non-enhancing, disseminated in space and time[6] Urinary tract infections, depression, social, vocational and psychological complications[10]
Antiphospholipid antibody syndrome[11] Arterial thrombosis (TIA, stroke), venous thrombosis leading to pulmonary embolism and pulmonary hypertension, fetal loss, livedo reticularis, response to anticoagulant therapy Mitral and aortic valvular involvement[12], hypertension, abnormal localisation of lesion on MRI, positive Coombs test, proteinuria, renal failure Clinical criteria plus presence of lupus anti-coagulant or moderate titres of IgG or IgM anti-cardiolipin or anti-beta-2-glycoprotein-I antibodies on two samples at least 12 weeks apart [13] Skin ulcerations, thrombocytopenia[14], hemolytic anemia, sudden visual loss/ deafness,

References

  1. ↑ Kennedy PG (2004). "Viral encephalitis: causes, differential diagnosis, and management". J Neurol Neurosurg Psychiatry. 75 Suppl 1: i10–5. doi:10.1136/jnnp.2003.034280. PMC 1765650. PMID 14978145.
  2. ↑ "StatPearls". 2022. PMID 32310354 Check |pmid= value (help).
  3. ↑ Nir TM, Jahanshad N, Busovaca E, Wendelken L, Nicolas K, Thompson PM; et al. (2014). "Mapping white matter integrity in elderly people with HIV". Hum Brain Mapp. 35 (3): 975–92. doi:10.1002/hbm.22228. PMC 3775847. PMID 23362139.
  4. ↑ Valcour V, Paul R, Chiao S, Wendelken LA, Miller B (2011). "Screening for cognitive impairment in human immunodeficiency virus". Clin Infect Dis. 53 (8): 836–42. doi:10.1093/cid/cir524. PMC 3174098. PMID 21921226.
  5. ↑ Gelfand JM (2014). "Multiple sclerosis: diagnosis, differential diagnosis, and clinical presentation". Handb Clin Neurol. 122: 269–90. doi:10.1016/B978-0-444-52001-2.00011-X. PMID 24507522.
  6. ↑ 6.0 6.1 Garg RK (2003). "Acute disseminated encephalomyelitis". Postgrad Med J. 79 (927): 11–7. doi:10.1136/pmj.79.927.11. PMC 1742586. PMID 12566545.
  7. ↑ Gronseth GS, Ashman EJ (2000). "Practice parameter: the usefulness of evoked potentials in identifying clinically silent lesions in patients with suspected multiple sclerosis (an evidence-based review): Report of the Quality Standards Subcommittee of the American Academy of Neurology". Neurology. 54 (9): 1720–5. doi:10.1212/wnl.54.9.1720. PMID 10802774.
  8. ↑ Greene DN, Schmidt RL, Wilson AR, Freedman MS, Grenache DG (2012). "Cerebrospinal fluid myelin basic protein is frequently ordered but has little value: a test utilization study". Am J Clin Pathol. 138 (2): 262–72. doi:10.1309/AJCPCYCH96QYPHJM. PMID 22904139.
  9. ↑ Shah I, James R, Barker J, Petroczi A, Naughton DP (2011). "Misleading measures in Vitamin D analysis: a novel LC-MS/MS assay to account for epimers and isobars". Nutr J. 10: 46. doi:10.1186/1475-2891-10-46. PMC 3114718. PMID 21569549.
  10. ↑ Gelfand JM (2014). "Multiple sclerosis: diagnosis, differential diagnosis, and clinical presentation". Handb Clin Neurol. 122: 269–90. doi:10.1016/B978-0-444-52001-2.00011-X. PMID 24507522.
  11. ↑ Cuadrado MJ, Khamashta MA, Ballesteros A, Godfrey T, Simon MJ, Hughes GR (2000). "Can neurologic manifestations of Hughes (antiphospholipid) syndrome be distinguished from multiple sclerosis? Analysis of 27 patients and review of the literature". Medicine (Baltimore). 79 (1): 57–68. doi:10.1097/00005792-200001000-00006. PMID 10670410.
  12. ↑ Espínola-Zavaleta N, Vargas-Barrón J, Colmenares-Galvis T, Cruz-Cruz F, Romero-Cárdenas A, Keirns C; et al. (1999). "Echocardiographic evaluation of patients with primary antiphospholipid syndrome". Am Heart J. 137 (5): 973–8. doi:10.1016/s0002-8703(99)70424-2. PMID 10220649.
  13. ↑ Miyakis S, Lockshin MD, Atsumi T, Branch DW, Brey RL, Cervera R; et al. (2006). "International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS)". J Thromb Haemost. 4 (2): 295–306. doi:10.1111/j.1538-7836.2006.01753.x. PMID 16420554.
  14. ↑ Cervera R, Piette JC, Font J, Khamashta MA, Shoenfeld Y, Camps MT; et al. (2002). "Antiphospholipid syndrome: clinical and immunologic manifestations and patterns of disease expression in a cohort of 1,000 patients". Arthritis Rheum. 46 (4): 1019–27. doi:10.1002/art.10187. PMID 11953980.

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