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Differential diagnosis

Diseases	Symptoms				Physical Examination					Past medical history	Diagnostic tests			Other Findings
	Headache	↓LOC	Motor weakness	Abnormal sensory	Motor Deficit	Sensory deficit	Speech difficulty	Gait abnormality	Cranial nerves		CT /MRI	CSF Findings	Gold standard test
Meningitis or encephalitis	+	-	-	-	-	+	+	-	-	History of fever and malaise	-	↑ Leukocytes, ↑ Protein ↓ Glucose	CSF analysis	Fever, neck rigidity
Brain tumor	+	-	-	-	+	+	+	-	+	Weight loss, fatigue	+	Cancer cells	MRI	Cachexia, gradual progression of symptoms
Hemorrhagic stroke	+	+	+	+	+	+	+	+	-	Hypertension	+	-	CT scan without contrast	Neck stiffness
Subdural hemorrhage	+	+	+	+	+	-	-	-	+	Trauma, fall	+	Xanthochromia	CT scan without contrast	Confusion, dizziness, nausea, vomiting
Neurosyphilis	+	-	+	+	+	+	-	+	-	STIs	+	↑ Leukocytes and protein	CSF VDRL-specifc CSF FTA-Ab -sensitive	Blindness, confusion, depression, Abnormal gait
Hypertensive encephalopathy	+	+	-	-	-	-	+	+	-	Hypertension	+	-	Clinical assesment	Delirium, cortical blindness, cerebral edema, seizure
Wernicke’s encephalopathy	-	+	-	-	-	+	+	+	+	History of alcohal abuse	-	-	Clinical assesment and lab findings	Ophthalmoplegia, confusion
CNS abscess	+	+	-	-	+	+	+	-	-	History of drug abuse, endocarditis, immunosupression	+	↑ leukocytes, ↓ glucose and ↑ protien	MRI is more sensitive and specific	High grade fever, fatigue,nausea, vomiting
Drug toxicity	-	+	-	+	+	+	-	+	-	-	-	-	Drug screen test	Lithium, Sedatives, phenytoin, carbamazepine
Conversion disorder	+	+	+	+	+	+	+	+		History of emotional stress	-	-	Diagnosis of exclusion	Tremors, blindness, difficulty swallowing
Metabolic disturbances (electrolyte imbalance, hypoglycemia)	-	+	+	+	+	+	-	-	+	-	-	Hypoglycemia, hypo and hypernatremia, hypo and hyperkalemia	Depends on the cause	Confusion, seizure, palpitations, sweating, dizziness, hypoglycemia
Multiple sclerosis exacerbation	-	-	+	+	-	+	+	+	+	History of relapses and remissions	+	↑ CSF IgG levels (monoclonal bands)	Clinical assesment and MRI	Blurry vision, urinary incontinence, fatigue
Seizure	+	+	-	-	+	+	-	-	+	Previous history of seizures	-	Mass lesion	Clinical assesment and EEG	Confusion, apathy, irritability,

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Diseases	History and Physical					Diagnostic tests		Other Findings
	Prodromal symptoms	Fever	Headache	LOC	Neuro Onset	Laboratory Findings	Imaging
Rabies infection	+	+	+	+	Insidious			Hydrophobia, aerophobia, dysphagia, and localized pain, weakness or paresthesias
Meningitis	+	+	+	-	Sudden	CSF analysis: ↑ Leukocytes ↑ Protein ↓ Glucose		Fever, neck, rigidity
encephalitis	+			+				Accompany a meningoencephalitis, seizures, hemiparesis, cranial nerve palsies, photophobia, nausea
Autoimmune encephalitis	-	+/-	+	+/-	Insidious			Memory deficit, dyskinesias, seizures, autonomic instability
CNS abscess	+	+	+	+	Insidious	CSF analysis: ↑ leukocytes ↓ glucose ↑ protien	MRI is more sensitive and specific	High grade fever, fatigue,nausea, vomiting
Poliomyelitis					Sudden	PCR of CSF		Asymmetric paralysis following a flu-like syndrome.
Neurosyphilis					Insidious	CSF VDRL-specifc CSF FTA-Ab -sensitive	MRI & Lumbar puncture	History of unprotected sex or multiple sexual partners, and genital ulcer (chancre) Blindness, confusion, depression, abnormal gait
Tick paralysis (Dermacentor tick)				+	Insidious	-	-	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)
Adult Botulism					Sudden	Toxin test, Blood, Wound, or Stool culture		Diplopia, Hyporeflexia, Hypotonia, possible respiratory paralysis, Floppy baby syndrome
Electrolyte disturbance					Insidious	Electrolyte panel: ↓Ca++, ↓Mg++, ↓K+		Possible arrhythmia
Tetrodotoxin poisoning					Sudden	-	-	History of consumption of puffer fish species.
Metabolic disturbances (electrolyte imbalance, hypoglycemia)	-	+/-	-	+	Sudden	Hypoglycemia, hypo and hypernatremia, hypo and hyperkalemia		Confusion, seizure, palpitations, sweating, dizziness, hypoglycemia
Drug toxicity/Neuroleptic malignant syndrome	-	-	-	+				Causative medications (eg, neuroleptics, antiemetics, concomitant lithium), dopaminergic withdrawal, elevated creatine kinase
Organophosphate toxicity					Sudden	Clinical suspicion confirmed with RBC AchE activity		History of exposure to insecticide or living in farming environment. with : Diarrhea, Urination, Miosis, Bradycardia, Lacrimation, Emesis, Salivation, Sweating
Ischemic stroke					Sudden		MRI +ve for ischemia or hemorrhage	Sudden unilateral motor and sensory deficit in a patient with a history of atherosclerotic risk factors (diabetes, hypertension, smoking) or atrial fibrillation.
Hemorrhagic stroke			+	+	Sudden	-	CT scan without contrast	Neck stiffness
Subdural hemorrhage			+	+	Sudden	CSF analysis: Xanthochromia	CT scan without contrast	Confusion, dizziness, nausea, vomiting
Hypertensive encephalopathy	-	-	+	+	Sudden		-	Delirium, cortical blindness, cerebral edema, seizure
Wernicke’s encephalopathy	-	-	-	+	Sudden		-	Ophthalmoplegia, confusion
Guillian-Barre syndrome					Insidious	CSF: ↑Protein ↓Cells	-	Progressive ascending paralysis following infection, possible respiratory paralysis
Amyotrophic lateral sclerosis					Insidious	Normal LP (to rule out DDx)	MRI	Patient initially presents with upper motor neuron deficit (spasticity) followed by lower motor neuron deficit (flaccidity).
Diffuse glioma					Insidious	GFAP Normal CSF	MRI (expansile, T2 hyperintense lesion)
Primary or secondary central nervous system lymphoma					Insidious	CSF cytology, flow cytometry, and IgH gene rearrangement	MRI (parenchymal or leptomeningeal enhancement)