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| | <div style="height:210px; background-color:#dee6e8; padding-left:30px; box-sizing:border-box; overflow:auto;"> |
| {{SK}} WEE; West equine encephalitis;
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| ==Overview== | | ==Overview== |
| Western equine encephalitis is a mild to moderate infection of the [[central nervous system]]. Western equine encephalitis belongs to the Group IV positive-sense ssRNA virus within the [[Togaviridae]] family of viruses, and the genus [[Alphavirus]]. Western equine encephalitis is closely related to [[eastern equine encephalitis]] virus and [[Venezuelan equine encephalitis]] virus. Western equine encephalitis virus is usually transmitted via [[mosquito]]s to the human host. Western equine encephalitis is contracted by the [[bite]] of an infected [[mosquito]], primarily ''Culiseta melanura'' and ''Culex tarsalis''. Western equine encephalitis virus must be differentiated from other diseases that cause [[fever]], [[headache]], [[seizures]], and [[altered mental status]]. The last observed case of western equine encephalitis in the United States occurred in 1999. Prognosis for western equine encephalitis is generally good; western equine encephalitis is considered more mild than [[eastern equine encephalitis]]. [[invasive|Neuroinvasive]] vs non-neuroinvasive western equine encephalitis can be differentiated based on both clinical and laboratory findings. The diagnostic method of choice for western equine encephalitis is laboratory testing. The positive presence of [[IgM]] [[antibody|antibodies]] is diagnostic of western equine encephalitis. There is no treatment for western equine encephalitis virus; the mainstay of therapy is supportive care. There are currently no human vaccines available for western equine encephalitis.
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| ==Historical Perspective== | | ==Historical Perspective== |
| Western equine encephalitis was first identified by Karl Friedrich Meyer, an American scientist of Swiss origin, in 1930 following an epizootic outbreak in horses in the San Joaquin Valley in California.<ref name="pmid17834966">{{cite journal| author=Meyer KF, Haring CM, Howitt B| title=THE ETIOLOGY OF EPIZOOTIC ENCEPHALOMYELITIS OF HORSES IN THE SAN JOAQUIN VALLEY, 1930. | journal=Science | year= 1931 | volume= 74 | issue= 1913 | pages= 227-8 | pmid=17834966 | doi=10.1126/science.74.1913.227 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17834966 }} </ref>
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| ==Classification== | | ==Classification== |
| Western equine encephalitis may be classified according to location of the disease into 2 subtypes: systemic or encephalitic. Western equine encephalitis may also be classified according to [[invasive|neuroinvasiveness]] of the disease into 2 subtypes: neuroinvasive and non-neuroinvasive. Western equine encephalitis belongs to the Group IV positive-sense ssRNA virus within the [[Togaviridae]] family of viruses, and the genus [[Alphavirus]]. Western equine encephalitis is closely related to [[eastern equine encephalitis]] virus and [[Venezuelan equine encephalitis]] virus. Western equine encephalitis is known as an [[arbovirus]], or an arthropod-borne virus.
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| ==Pathophysiology== | | ==Pathophysiology== |
| Western equine encephalitis virus is usually transmitted via [[mosquito]]s to the human host. Western equine encephalitis virus contains [[positive-sense ssRNA virus|positive-sense]] viral [[RNA]]; this RNA has its genome directly utilized as if it were mRNA, producing a single protein which is modified by host and viral proteins to form the various proteins needed for [[replication]]. The following table is a summary of the western equine encephalitis virus:<ref name=ViralZoneAlpha> Alphavirus. SIB Swiss Institute of Bioinformatics. http://viralzone.expasy.org/viralzone/all_by_species/625.html Accessed on March 15, 2016 </ref>
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| {| class="wikitable"
| | ==Causes== |
| ! style="text-align: center; font-weight: bold;" | Characteristic
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| ! style="text-align: center; font-weight: bold;" | Data
| |
| |-
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| | Nucleic acid
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| | [[RNA]]
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| |-
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| | Sense
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| | [[positive-sense ssRNA virus|ssRNA(+)]]
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| |-
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| | Virion
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| | [[enveloped virus|Enveloped]]
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| |-
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| | [[Capsid]]
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| | Spherical
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| |-
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| | Symmetry
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| | Yes; T=4 [[icosahedral]]
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| |-
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| | Capsid [[monomers]]
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| | 240
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| |-
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| | Monomer length (diameter)
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| | 65-70 nm
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| |-
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| | Additional envelope information
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| | 80 spikes; each spike is a [[trimer]] of E1/E2 proteins
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| |-
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| | Genome shape
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| | Linear
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| |-
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| | Genome length
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| | 11-12 kb
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| |-
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| | [[Nucleotide]] cap
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| | Yes
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| |-
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| | [[Polyadenylation|Polyadenylated]] tail
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| | Yes
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| |-
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| | [[Incubation period]]
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| | 5-10 days
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| |}
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| Western equine encephalitis is contracted by the [[bite]] of an infected [[mosquito]], primarily ''Culiseta melanura'' and ''Culex tarsalis''. The virus is maintained in a cycle between either of the mosquitos and avian hosts in [[freshwater]] hardwood swamps. Neither are an important vector of western equine virus to humans because both feed almost exclusively on birds. Transmission to humans requires mosquito species capable of creating a "bridge" between infected birds and uninfected mammals, such as some ''[[Aedes]]'', ''Coquillettidia'', and other ''Culex'' species. The [[incubation period]] is 5-10 days.<ref name=WEEOhioPH> WESTERN EQUINE ENCEPHALITIS VIRUS DISEASE. Ohio Department of Health. http://www.odh.ohio.gov/pdf/IDCM/wee.pdf Accessed on March 22, 2016.</ref> Humans and horses are dead-end hosts for the virus, meaning there is an insufficient amount of western equine encephalitis virus in the blood stream to infect a mosquito. Many cases in horses are fatal. There is no known transmission between horses and humans.<ref name=EEEVILPubHealth> Eastern Equine Encephalitis Virus (EEEV). Illinois Department of Public Health (2010) http://www.idph.state.il.us/public/hb/hb_eee.htm Accessed on March 15, 2016. </ref> Recent studies have demonstrated other equine, such as mules and donkeys, and other animals, such as pigs, reptiles, amphibians, and rodents, can be infected.
| | ==Differentiating {{PAGENAME}} from Other Diseases== |
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| Western equine encephalitis virus is transmitted in the following pattern:<ref name=ViralZoneAlpha> Alphavirus. SIB Swiss Institute of Bioinformatics. http://viralzone.expasy.org/viralzone/all_by_species/625.html Accessed on March 15, 2016 </ref>
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| #Attachment of the viral E [[glycoprotein]] to host receptors mediates [[clathrin|clathrin-mediated]] [[endocytosis]] of virus into the host cell.
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| #Fusion of [[biological membrane|virus membrane]] with the host [[cell membrane]]. RNA genome is released into the [[cytoplasm]].
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| #The [[positive-sense ssRNA virus]] is [[translate]]d into a [[polyprotein]], which is cleaved into non-structural proteins necessary for RNA synthesis ([[replication]] and [[transcription]]).
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| #[[Replication]] takes place in [[cytoplasm]]ic viral factories at the surface of [[endosome]]s. A [[dsRNA]] [[genome]] is synthesized from the genomic ssRNA(+).
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| #The [[dsRNA]] [[genome]] is [[transcribed]] thereby providing viral [[mRNA]]s (new ssRNA(+) genomes).
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| #Expression of the subgenomic RNA (sgRNA) gives rise to the structural proteins.
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| #Virus assembly occurs at the [[endoplasmic reticulum]].
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| #[[Virion]]s bud at the [[endoplasmic reticulum]], are transported to the [[Golgi apparatus]], and then exit the cell via the [[secretory pathway]].
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| ==Causes==
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| Western equine encephalitis may be caused by western equine encephalitis virus.
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| ==Differentiating Western equine encephalitis from Other Diseases==
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| Western equine encephalitis virus must be differentiated from other diseases that cause [[fever]], [[headache]], [[seizures]], and [[altered mental status]], such as:<ref name=Mandell1> M.D. JE, Dolin R, Blaser MJ. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, Expert Consult Premium Edition. Saunders; 2014.</ref><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= | pmc=PMC1765650 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14978145 }} </ref><ref name=NYDeptofHealth> Arboviral Infections (arthropod-borne encephalitis, eastern equine encephalitis, St. Louis encephalitis, California encephalitis, Powassan encephalitis, West Nile encephalitis). New York State Department of Health (2006). https://www.health.ny.gov/diseases/communicable/arboviral/fact_sheet.htm Accessed on February 23, 2016 </ref>
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| {| style="border: 0px; font-size: 90%; margin: 3px;" align=center
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| |+
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| ! style="background: #4479BA; width: 120px;" | {{fontcolor|#FFF|Disease}}
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| ! style="background: #4479BA; width: 550px;" | {{fontcolor|#FFF|Findings}}
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| |-
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| | style="padding: 5px 5px; background: #DCDCDC;" | '''[[Eastern equine encephalitis]]'''
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| | style="padding: 5px 5px; background: #F5F5F5;" |[[Eastern eqyube encephalitis]] presents with acute [[inflammation]] of the [[brain]], caused by an [[arbovirus|arboviral infection]]; it is less severe than Eastern equine encephalitis. Other findings include [[fever]], [[nausea]], [[headache]], [[vomit]]ing, [[photophobia]], [[seizure]]s, and [[coma]].
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| |-
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| | style="padding: 5px 5px; background: #DCDCDC;" | '''[[Venezuelan equine encephalitis]]'''
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| | style="padding: 5px 5px; background: #F5F5F5;" |[[Venezuelan equine encephalitis]] presents with acute [[inflammation]] of the [[brain]], caused by an [[arbovirus|arboviral infection]]; complications include severe [[brain]] damage. Other findings include [[fever]], [[nausea]], [[headache]], [[photophobia]], [[seizure]]s, and [[coma]].
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| |-
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| | style="padding: 5px 5px; background: #DCDCDC;" | '''[[Vector-borne encephalitis]]'''
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| | style="padding: 5px 5px; background: #F5F5F5;" |[[Vector-borne encephalitis]] presents with acute [[inflammation]] of the [[brain]], caused by a [[bacterial infection]]; complications include severe [[brain]] damage as the inflamed [[brain]] pushes against the [[skull]], potentially leading to [[mortality]]. {{see also|Tick-borne encephalitis|California encephalitis virus|La Crosse encephalitis|Japanese encephalitis|West Nile encephalitis}}
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| |-
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| | style="padding: 5px 5px; background: #DCDCDC;" | '''[[Viral encephalitis]] '''
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| | style="padding: 5px 5px; background: #F5F5F5;" |[[Viral encephalitis]] presents with acute [[inflammation]] of the [[brain]], caused by a [[viral infection]]; complications include severe [[brain]] damage as the inflamed [[brain]] pushes against the [[skull]], potentially leading to [[mortality]]. {{see also|Herpes simplex encephalitis|VZV encephalitis}}
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| | style="padding: 5px 5px; background: #DCDCDC;" | '''[[Encephalopathy]]'''
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| | style="padding: 5px 5px; background: #F5F5F5;" |[[Encephalopathy]] presents with steady [[depression]], generalized [[seizures]]. Generally absent are [[fever]], [[headache]], [[leukocytosis]], and [[pleocytosis]]; [[MRI]] often appears normal.
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| |-
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| | style="padding: 5px 5px; background: #DCDCDC;" | '''[[Meningitis]]'''
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| | style="padding: 5px 5px; background: #F5F5F5;" |[[Meningitis]] presents with [[headache]], [[altered mental status]], and [[inflammation]] of the [[meninges]], which may develop in the setting of an [[infection]], physical injury, [[cancer]], or certain drugs; it may have an indolent evolution, resolving on its own, or may present as an rapidly evolving [[inflammation]], causing neurologic damage and possible [[mortality]]. {{see also|Bacterial meningitis|Viral meningitis|Fungal meningitis}}
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| | style="padding: 5px 5px; background: #DCDCDC;" |'''[[Brain abscess]]'''
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| | style="padding: 5px 5px; background: #F5F5F5;" |[[Brain abscess]] presents with an [[abscess]] in the [[brain]] caused by the [[inflammation]] and accumulation of [[infected]] material from local or remote infectious areas of the body; the infectious agent may also be introduced as a result of head [[trauma]] or [[neurosurgery|neurological procedures]].
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| | style="padding: 5px 5px; background: #DCDCDC;" | '''[[Acute disseminated encephalomyelitis]] (ADEM)'''
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| | style="padding: 5px 5px; background: #F5F5F5;" |[[Acute disseminated encephalomyelitis]] presents with scattered foci of [[demyelination]] and perivenular [[inflammation]]; it can cause focal neurological signs and decreased ability to focus.
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| |}
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| ==Epidemiology and Demographics== | | ==Epidemiology and Demographics== |
| Between 1964-2012, there were 640 confirmed human cases in the United States; the last one was observed in 1999.<ref name=WEEOhioPH> WESTERN EQUINE ENCEPHALITIS VIRUS DISEASE. Ohio Department of Health. http://www.odh.ohio.gov/pdf/IDCM/wee.pdf Accessed on March 22, 2016.</ref> In April 2009, the last known Western equine encephalitis fatality occurred in Uruguay.<ref name="pmid21529429">{{cite journal| author=Delfraro A, Burgueño A, Morel N, González G, García A, Morelli J et al.| title=Fatal human case of Western equine encephalitis, Uruguay. | journal=Emerg Infect Dis | year= 2011 | volume= 17 | issue= 5 | pages= 952-4 | pmid=21529429 | doi=10.3201/eid1705.101068 | pmc=PMC3321764 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21529429 }} </ref> The case-fatality rate of western equine encephalitis is < 5%.<ref name=IDSAEnceph> The Management of Encephalitis: Clinical Practice Guidelines by the Infectious Diseases Society of America. http://www.idsociety.org/uploadedFiles/IDSA/Guidelines-Patient_Care/PDF_Library/Encephalitis.pdf Accessed on February 16, 2016.</ref>
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| ===Age=== | | ==Risk Factors== |
| Western equine encephalitis is most commonly observed among children under 4 years of age and adults over 50 years of age.<ref name=IDSAEnceph> The Management of Encephalitis: Clinical Practice Guidelines by the Infectious Diseases Society of America. http://www.idsociety.org/uploadedFiles/IDSA/Guidelines-Patient_Care/PDF_Library/Encephalitis.pdf Accessed on February 16, 2016.</ref>
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| ===Race=== | | ==Screening== |
| There is no racial predilection for western equine encephalitis.
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| ===Seasonal===
| | ==Natural History, Complications, and Prognosis== |
| Western equine encephalitis is most commonly observed in the summer months.
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| ===Geographic Distribution===
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| Western equine encephalitis virus has been observed in North, Central, and South America; most cases have been reported from the Great Plains and Western regions of the United States.
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| ==Risk Factors==
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| Common risk factors in the development of western equine encephalitis are:
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| *[[Age]]
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| *[[Immunosuppression]]
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| *Residing or visiting woodland areas
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| *[[Mosquito]] contact
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| *Bird contact
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| *Horse contact
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| *Summer season
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| *Outdoor recreational activities
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| ==Natural History, Complications and Prognosis== | |
| ===Natural History=== | | ===Natural History=== |
| If left untreated, approximately 10% patients with western equine encephalitis may progress to develop a [[febrile]] [[prodrome]] followed by [[meningismus]], [[weakness]], [[tremor]]s, and [[altered mental status]].
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| ===Complications=== | | ===Complications=== |
| Complications of western equine encephalitis include:
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| *[[Seizure]]s
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| *Loss of basic [[motor skill]]s
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| *Loss of [[coordination]]
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| *[[Meningitis]]
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| ===Prognosis=== | | ===Prognosis=== |
| Prognosis for western equine encephalitis is generally good; western equine encephalitis is considered more mild than [[eastern equine encephalitis]].
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| ==Diagnosis== | | ==Diagnosis== |
| ===Diagnostic criteria=== | | ===Diagnostic Criteria=== |
| Neuroinvasive vs non-neuroinvasive western equine encephalitis can be differentiated based on both clinical and laboratory findings. These include:<ref name=WVPubHealth> Arboviral Infection: Surveillance Protocol (2016) West Virginia Department of Health and Human Resources: Bureau of Public Health (2016). http://www.dhhr.wv.gov/oeps/disease/Zoonosis/Mosquito/Documents/arbovirus/arbovirus-protocol.pdf Accessed on March 3, 2016 </ref>
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| {| class="wikitable"
| | ===History and Symptoms=== |
| ! style="text-align: center; font-weight: bold;" | Western Equine Encephalitis Subtype
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| ! style="text-align: center; font-weight: bold;" | Clinical Presentation
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| ! style="text-align: center; font-weight: bold;" | Laboratory Findings
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| |-
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| | style="font-style: italic;" | Neuroinvasive
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| :{{unicode|☑}} [[Meningitis]], [[encephalitis]], acute flaccid [[paralysis]], or other acute signs of central or peripheral neurologic dysfunction, as documented by a [[physician]] '''AND'''
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| :{{unicode|☑}} Absence of a more likely clinical explanation
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| :{{unicode|☑}} Isolation of [[virus]] from, or demonstration of specific viral [[antigen]] or [[nucleic acid in]], [[tissue]], [[blood]], [[cerebrospinal fluid]] (CSF) '''OR'''
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| :{{unicode|☑}} Four-fold or greater change in virus-specific quantitative antibody [[titer]]s in paired sera '''OR'''
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| :{{unicode|☑}} Virus-specific [[IgM]] antibodies in [[serum]] with confirmatory virus-specific neutralizing antibodies in the same or a later specimen '''OR'''
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| :{{unicode|☑}} Virus-specific [[IgM]] antibodies in [[cerebrospinal fluid]], with or without a reported [[pleocytosis]], and a negative result for other IgM antibodies in cerebrospinal fluid for arboviruses endemic to the region where exposure occurred
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| |-
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| | style="font-style: italic;" | Non-neuroinvasive
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| :{{unicode|☑}} [[Fever]] and [[chills]] as reported by the [[patient]] or a [[health care provider]] '''AND'''
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| :{{unicode|☑}} Absence of [[invasive|neuroinvasive]] disease '''AND'''
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| :{{unicode|☑}} Absence of a more likely clinical explanation
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| :{{unicode|☑}} Isolation of [[virus]] from, or demonstration of specific viral [[antigen]] or [[nucleic acid]] in, [[tissue]], [[blood]], or other body fluid, excluding [[cerebrospinal fluid]] '''OR'''
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| :{{unicode|☑}} Four-fold or greater change in virus-specific quantitative antibody [[titer]]s in paired sera '''OR'''
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| :{{unicode|☑}} Virus-specific [[IgM]] antibodies in [[serum]] with confirmatory virus-specific neutralizing antibodies in the same or a later specimen
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| |}
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| ===History and Symptoms===
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| If possible, a detailed and thorough history from the patient is necessary. Common symptoms of western equine encephalitis include:<ref name=Mandell1> M.D. JE, Dolin R, Blaser MJ. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, Expert Consult Premium Edition. Saunders; 2014.</ref><ref name= NINDS> Meningitis and Encephalitis Fact Sheet. National Institute of Neurological Disorders and Stroke. National Institutes of Health (2015). http://www.ninds.nih.gov/disorders/encephalitis_meningitis/detail_encephalitis_meningitis.htm Accessed on February 9, 2015 </ref>
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| *[[Fever]]
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| *[[Chills]]
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| *[[Headache]]
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| *[[Fatigue]]
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| *[[myalgia|Muscle pain]]
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| *[[Dizziness]]
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| *[[Altered mental status]]
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| ===Physical Examination=== | | ===Physical Examination=== |
| Common physical examination findings of western equine encephalitis include:<ref name="pmid20551475">{{cite journal| author=Steele KE, Twenhafel NA| title=REVIEW PAPER: pathology of animal models of alphavirus encephalitis. | journal=Vet Pathol | year= 2010 | volume= 47 | issue= 5 | pages= 790-805 | pmid=20551475 | doi=10.1177/0300985810372508 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20551475 }} </ref>
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| *[[Fever]]
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| *[[Ataxia]]
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| *[[Seizure]]s
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| *[[Obtundation]]
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| *[[Myalgia]]
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| *[[myelitis|Acute flaccid myelitis]]
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| *[[Lethargy]]
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| *[[Meningism]]
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| *[[Photophobia]]
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| *[[Somnolence]]
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| *[[Coma]]
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| *[[Motor neuron]] dysfunction
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| ===Laboratory Findings=== | | ===Laboratory Findings=== |
| The diagnostic method of choice for western equine encephalitis is laboratory testing. The positive presence of [[IgM]] [[antibody|antibodies]] is diagnostic of western equine encephalitis. Other laboratory findings consistent with the diagnosis of western equine encephalitis include:<ref name=IDSAEnceph> The Management of Encephalitis: Clinical Practice Guidelines by the Infectious Diseases Society of America. http://www.idsociety.org/uploadedFiles/IDSA/Guidelines-Patient_Care/PDF_Library/Encephalitis.pdf Accessed on February 16, 2016.</ref>
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| *[[Serologic]] [[cross-reactivity]]
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| *Persistence of [[IgG]] and neutralizing [[antibody|antibodies]]
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| *Confirmation of arboviral-specific neutralizing antibodies in [[enzyme linked immunosorbent assay (ELISA)]]
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| *In [[cerebrospinal fluid]]:
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| **[[Pleocytosis]]
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| **Increased protein levels
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| **Normal to slightly elevated [[glucose]] levels
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| ===Imaging Findings=== | | ===Imaging Findings=== |
| There are no imaging findings specifically associated with western equine encephalitis. [[MRI]] is the modality of choice to evaluate all types of encephalitis. Although the pattern of involvement varies, in general, sites of involvement include:<ref name=EncephGeneralMRI> Flavivirus encephalitis. Radiopaedia.org (2016). http://radiopaedia.org/articles/flavivirus-encephalitis Accessed on March 29, 2016. </ref>
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| *T2 hyperintensity in the [[basal ganglia]] and [[thalamus]]
| | ===Other Diagnostic Studies=== |
| *Restricted diffusion in the [[basal ganglia]] and [[thalamus]]
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| *[[Hemorrhage]] less frequently
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| ==Treatment== | | ==Treatment== |
| ===Medical Therapy=== | | ===Medical Therapy=== |
| There is no treatment for western equine encephalitis; the mainstay of therapy is supportive care. Because supportive care is the only treatment for western equine encephalitis, physicians often do not request the tests required to specifically identify the western equine encephalitis virus.
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| ===Surgery=== | | ===Surgery=== |
| Surgical intervention is not recommended for the management of western equine encephalitis.
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| ===Prevention=== | | ===Prevention=== |
| There is no human vaccine for western equine encephalitis. There is a western equine encephalitis vaccine available for horses. In consultation with a veterinarian, vaccinate your horse(s) against the virus. Primary prevention strategies for western equine encephalitis include:<ref name=EEENYPubHealth> Eastern Equine Encephalitis (EEE). New York State Department of Public Health (2012). https://www.health.ny.gov/diseases/communicable/eastern_equine_encephalitis/fact_sheet.htm Accessed on March 15, 2016.</ref>
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| *Removal of [[standing water]]
| | ==References== |
| *Screens on doors and windows
| | {{reflist|2}} |
| *When outdoors, wearing:
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| **Insect repellent containing [[DEET]]
| | {{WS}} |
| **Long sleeves, pants; tucking in pants into high socks
| | {{WH}} |
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| | =Encephalitis Table= |
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| | Reference list includes:<ref name="pmid21932127">{{cite journal| author=Eckstein C, Saidha S, Levy M| title=A differential diagnosis of central nervous system demyelination: beyond multiple sclerosis. | journal=J Neurol | year= 2012 | volume= 259 | issue= 5 | pages= 801-16 | pmid=21932127 | doi=10.1007/s00415-011-6240-5 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21932127 }} </ref><ref name="pmid11260760">{{cite journal| author=De Kruijk JR, Twijnstra A, Leffers P| title=Diagnostic criteria and differential diagnosis of mild traumatic brain injury. | journal=Brain Inj | year= 2001 | volume= 15 | issue= 2 | pages= 99-106 | pmid=11260760 | doi=10.1080/026990501458335 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11260760 }} </ref> |
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| | {| style="border: 0px; font-size: 90%; margin: 3px;" align=center |
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| | ! style="background: #4479BA; width: 50px;" | {{fontcolor|#FFF|Disease}} |
| | ! style="background: #4479BA; width: 100px;" | {{fontcolor|#FFF|Similarities}} |
| | ! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF|Differentials}} |
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| | | style="padding: 5px 5px; background: #DCDCDC;" | '''[[Meningitis]]''' |
| | | style="padding: 5px 5px; background: #F5F5F5;" | Classic triad of [[fever]], [[nuchal rigidity]], and [[altered mental status]] |
| | | style="padding: 5px 5px; background: #F5F5F5;" |[[Photophobia]], [[phonophobia]], [[rash]] associated with [[meningococcemia]], concomitant [[sinusitis]] or [[otitis]], swelling of the [[fontanelle]] in infants (0-6 months) |
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| | | style="padding: 5px 5px; background: #DCDCDC;" |'''[[Brain abscess]]''' |
| | | style="padding: 5px 5px; background: #F5F5F5;" | [[Fever]], [[headache]], [[hemiparesis]] |
| | | style="padding: 5px 5px; background: #F5F5F5;" |Varies depending on the location of the abscess; clinically, [[visual disturbance]] including [[papilledema]], decreased [[sensation]]; on imaging, a [[lesion]] demonstrates both ring enhancement and central restricted diffusion |
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| | | style="padding: 5px 5px; background: #DCDCDC;" | '''[[Demyelinating disease]]s''' |
| | | style="padding: 5px 5px; background: #F5F5F5;" | [[Ataxia]], [[lethargy]] |
| | | style="padding: 5px 5px; background: #F5F5F5;" |[[Multiple sclerosis]]: clinically, [[nystagmus]], [[internuclear ophthalmoplegia]], [[Lhermitte's sign]]; on imaging, well-demarcated ovoid lesions with possible T1 hypointensities (“black holes”) |
| | [[Acute disseminated encephalomyelitis]]: clinically, [[somnolence]], [[myoclonic]] movements, and [[hemiparesis]]; on imaging, diffuse or multi-lesion enhancement, with indistinct lesion borders |
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| | | style="padding: 5px 5px; background: #DCDCDC;" | '''[[Substance abuse]]''' |
| | | style="padding: 5px 5px; background: #F5F5F5;" | [[Tremor]], [[headache]], [[altered mental status]] |
| | | style="padding: 5px 5px; background: #F5F5F5;" |Varies depending on type of substance: prior history, drug-seeking behavior, attention-seeking behavior, [[paranoia]], sudden [[panic]], [[anxiety]], [[hallucination]]s |
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| | | style="padding: 5px 5px; background: #DCDCDC;" | '''[[Electrolyte disturbance]]''' |
| | | style="padding: 5px 5px; background: #F5F5F5;" | [[Fatigue]], [[headache]], [[nausea]] |
| | | style="padding: 5px 5px; background: #F5F5F5;" |Varies depending on deficient ions; clinically, [[edema]], [[constipation]], [[hallucination]]s; on [[EKG]], abnormalities in [[T wave]], [[P wave]], [[QRS complex]]; possible presentations include [[arrhythmia]], [[dehydration]], [[renal failure]] |
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| | | style="padding: 5px 5px; background: #DCDCDC;" | '''[[Stroke]]''' |
| | | style="padding: 5px 5px; background: #F5F5F5;" | [[Ataxia]], [[aphasia]], [[dizziness]] |
| | | style="padding: 5px 5px; background: #F5F5F5;" |Varies depending on classification of stroke; presents with positional [[vertigo]], high [[blood pressure]], [[extremities|extremity]] weakness |
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| | | style="padding: 5px 5px; background: #DCDCDC;" | '''[[Intracranial hemorrhage]]''' |
| | | style="padding: 5px 5px; background: #F5F5F5;" | [[Headache]], [[coma]], [[dizziness]] |
| | | style="padding: 5px 5px; background: #F5F5F5;" | Lobar [[hemorrhage]], [[numbness]], [[tingling]], [[hypertension]], [[hemorrhagic diathesis]] |
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| | | style="padding: 5px 5px; background: #DCDCDC;" | '''[[Trauma]]''' |
| | | style="padding: 5px 5px; background: #F5F5F5;" | [[Headache]], [[altered mental status]] |
| | | style="padding: 5px 5px; background: #F5F5F5;" | [[Amnesia]], [[loss of consciousness]], [[dizziness]], [[concussion]], [[contusion]] |
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| | |} |
| | |
| | ==Treatment== |
| | Shown below is an algorithm summarizing the treatment of <nowiki>[[disease name]]</nowiki> according the the [...] guidelines. |
| | {{familytree/start |summary=PE diagnosis Algorithm.}} |
| | {{familytree | | | | | | | | A01 |A01= Do I know how this works?}} |
| | {{familytree | | | | |,|-|-|-|^|-|-|-|-|.| | | }} |
| | {{familytree | | | B01 | | | | | | | | B02 | | |B01=Yes, I'm an Honors Student |B02=No shot, this is wicked hard. }} |
| | {{familytree | | | |!| | | | | | | | | |!| }} |
| | {{familytree | | | C01 | | | | | | | | |!| |C01= Are you smart enough to split it off?}} |
| | {{familytree | |,|-|^|.| | | | | | | | |!| }} |
| | {{familytree | D01 | | D02 | | | | | | D03 |D01= Yes, I'm an Honors Student |D02= No, I guess I'm a pleb. |D03= Well wait, maybe some practice will help}} |
| | {{familytree | |!| | | |!| | | | |,|-|^|.| }} |
| | {{familytree | E01 | | |!| | | E02 | | E03 |E01= Good job. Way to live up to the hype. |E02= Yes! Practice Always Helps! |E03= Have you not seen this?}} |
| | {{familytree | |!| | | |!| | | | |!| | | |!| }} |
| | {{familytree | |!| | | |!| | F01 |'| | F02 |F01= You can learn anything in an hour! |F02= Go home and go to sleep. }} |
| | {{familytree | |!| | | |`|-|-|-|!|-|.| | |!| }} |
| | {{familytree | |`|-|-| G01 |-|-|'| |`|-| G02 | |G01= HONORS STUDENTS ARE NUMBER #1! |G02=RIP My GPA. }} |
| | {{familytree/end}} |
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| ==References== | | ==References== |
| {{Reflist|2}} | | {{Reflist|2}} |
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| [[Category:Viruses]]
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| [[Category:Neurology]]
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| [[Category:Infectious disease]]
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