Acute disseminated encephalomyelitis differential diagnosis: Difference between revisions
Jump to navigation
Jump to search
| (4 intermediate revisions by the same user not shown) | |||
| Line 3: | Line 3: | ||
{{CMG}}; {{AE}} {{Sujaya}} | {{CMG}}; {{AE}} {{Sujaya}} | ||
==Overview== | ==Overview== | ||
The [[differential]] diagnoses of [[Acute disseminated encephalomyelitis]] include: | |||
* [[Viral]] [[encephalitis]] | |||
* [[HIV]] [[encephalopathy]] | |||
* [[Multiple sclerosis]] | |||
* [[Antiphospholipid antibody syndrome]] | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
| Line 14: | Line 19: | ||
!Additional findings | !Additional findings | ||
|- | |- | ||
|'''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 | |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 | |[[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 [[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 | ||
|History of recent travel, animal bites ( | |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'''<ref name="pmid32310354">{{cite journal| author=| title=StatPearls | journal= | year= 2022 | volume= | issue= | pages= | pmid=32310354 | doi= | pmc= | url= }}</ref> | |'''[[HIV]] [[encephalopathy]]'''<ref name="pmid32310354">{{cite journal| author=| title=StatPearls | journal= | year= 2022 | volume= | issue= | pages= | pmid=32310354 | doi= | pmc= | url= }}</ref> | ||
|Waxing and waning pattern of psychomotor retardation, decreased memory, concentration and attention span. Tremor, ataxia, hyperreflexia, hypertonia, progressive decline in MMSE scores<ref name="pmid23362139">{{cite journal| author=Nir TM, Jahanshad N, Busovaca E, Wendelken L, Nicolas K, Thompson PM | display-authors=etal| title=Mapping white matter integrity in elderly people with HIV. | journal=Hum Brain Mapp | year= 2014 | volume= 35 | issue= 3 | pages= 975-92 | pmid=23362139 | doi=10.1002/hbm.22228 | pmc=3775847 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23362139 }}</ref>. Typical absence of cortical signs and symptoms | |Waxing and waning pattern of [[psychomotor]] [[retardation]], decreased [[memory]], concentration and attention span. [[Tremor]], [[ataxia]], [[hyperreflexia]], [[hypertonia]], progressive decline in [[MMSE]] scores<ref name="pmid23362139">{{cite journal| author=Nir TM, Jahanshad N, Busovaca E, Wendelken L, Nicolas K, Thompson PM | display-authors=etal| title=Mapping white matter integrity in elderly people with HIV. | journal=Hum Brain Mapp | year= 2014 | volume= 35 | issue= 3 | pages= 975-92 | pmid=23362139 | doi=10.1002/hbm.22228 | pmc=3775847 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23362139 }}</ref>. Typical absence of [[cortical]] [[signs]] and [[symptoms]] | ||
|Increase in CSF protein, cell count; multiple symmetric, hyperintense, non-enhancing subcortical foci on T2-weighted MRI<ref name="pmid21921226">{{cite journal| author=Valcour V, Paul R, Chiao S, Wendelken LA, Miller B| title=Screening for cognitive impairment in human immunodeficiency virus. | journal=Clin Infect Dis | year= 2011 | volume= 53 | issue= 8 | pages= 836-42 | pmid=21921226 | doi=10.1093/cid/cir524 | pmc=3174098 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21921226 }}</ref>. | |Increase in CSF protein, cell count; multiple symmetric, hyperintense, non-enhancing subcortical foci on T2-weighted MRI<ref name="pmid21921226">{{cite journal| author=Valcour V, Paul R, Chiao S, Wendelken LA, Miller B| title=Screening for cognitive impairment in human immunodeficiency virus. | journal=Clin Infect Dis | year= 2011 | volume= 53 | issue= 8 | pages= 836-42 | pmid=21921226 | doi=10.1093/cid/cir524 | pmc=3174098 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21921226 }}</ref>. | ||
|Identification of HIV RNA in CSF | |Identification of [[HIV]] [[RNA]] in [[CSF]] | ||
|Bowel and/or bladder complaints | |[[Bowel]] and/or [[bladder]] complaints | ||
|- | |- | ||
|'''Multiple sclerosis''' | |'''[[Multiple sclerosis]]''' | ||
|Sensory disturbances, walking difficulties, dizziness, vision problems, intestinal, urinary and sexual dysfunction, cognitive and emotional impairment<ref name="pmid24507522">{{cite journal| author=Gelfand JM| title=Multiple sclerosis: diagnosis, differential diagnosis, and clinical presentation. | journal=Handb Clin Neurol | year= 2014 | volume= 122 | issue= | pages= 269-90 | pmid=24507522 | doi=10.1016/B978-0-444-52001-2.00011-X | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24507522 }}</ref> | |[[Sensory]] disturbances, walking difficulties, [[dizziness]], [[vision]] problems, [[intestinal]], [[urinary]] and [[sexual]] dysfunction, [[cognitive]] and emotional impairment<ref name="pmid24507522">{{cite journal| author=Gelfand JM| title=Multiple sclerosis: diagnosis, differential diagnosis, and clinical presentation. | journal=Handb Clin Neurol | year= 2014 | volume= 122 | issue= | pages= 269-90 | pmid=24507522 | doi=10.1016/B978-0-444-52001-2.00011-X | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24507522 }}</ref> | ||
|MRI of the brain and spinal cord showing new lesions, both enhancing and non-enhancing, disseminated in space and time<ref name="pmid12566545">{{cite journal| author=Garg RK| title=Acute disseminated encephalomyelitis. | journal=Postgrad Med J | year= 2003 | volume= 79 | issue= 927 | pages= 11-7 | pmid=12566545 | doi=10.1136/pmj.79.927.11 | pmc=1742586 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12566545 }}</ref>; evoked potentials test demonstrate demyelination in the optic nerve and CNS<ref name="pmid10802774">{{cite journal| author=Gronseth GS, Ashman EJ| title=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. | journal=Neurology | year= 2000 | volume= 54 | issue= 9 | pages= 1720-5 | pmid=10802774 | doi=10.1212/wnl.54.9.1720 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10802774 }}</ref>; Myelin basic protein and IgG oligoclonal bands on CSF analysis<ref name="pmid22904139">{{cite journal| author=Greene DN, Schmidt RL, Wilson AR, Freedman MS, Grenache DG| title=Cerebrospinal fluid myelin basic protein is frequently ordered but has little value: a test utilization study. | journal=Am J Clin Pathol | year= 2012 | volume= 138 | issue= 2 | pages= 262-72 | pmid=22904139 | doi=10.1309/AJCPCYCH96QYPHJM | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22904139 }}</ref>; vitamin deficiencies in blood sample<ref name="pmid21569549">{{cite journal| author=Shah I, James R, Barker J, Petroczi A, Naughton DP| title=Misleading measures in Vitamin D analysis: a novel LC-MS/MS assay to account for epimers and isobars. | journal=Nutr J | year= 2011 | volume= 10 | issue= | pages= 46 | pmid=21569549 | doi=10.1186/1475-2891-10-46 | pmc=3114718 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21569549 }}</ref>. | |[[MRI]] of the [[brain]] and [[spinal cord]] showing new [[lesions]], both [[enhancing]] and [[non-enhancing]], disseminated in space and time<ref name="pmid12566545">{{cite journal| author=Garg RK| title=Acute disseminated encephalomyelitis. | journal=Postgrad Med J | year= 2003 | volume= 79 | issue= 927 | pages= 11-7 | pmid=12566545 | doi=10.1136/pmj.79.927.11 | pmc=1742586 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12566545 }}</ref>; [[evoked potentials]] test demonstrate [[demyelination]] in the [[optic]] [[nerve]] and [[CNS]]<ref name="pmid10802774">{{cite journal| author=Gronseth GS, Ashman EJ| title=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. | journal=Neurology | year= 2000 | volume= 54 | issue= 9 | pages= 1720-5 | pmid=10802774 | doi=10.1212/wnl.54.9.1720 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10802774 }}</ref>; [[Myelin]] basic [[protein]] and [[IgG]] [[oligoclonal]] bands on [[CSF]] analysis<ref name="pmid22904139">{{cite journal| author=Greene DN, Schmidt RL, Wilson AR, Freedman MS, Grenache DG| title=Cerebrospinal fluid myelin basic protein is frequently ordered but has little value: a test utilization study. | journal=Am J Clin Pathol | year= 2012 | volume= 138 | issue= 2 | pages= 262-72 | pmid=22904139 | doi=10.1309/AJCPCYCH96QYPHJM | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22904139 }}</ref>; [[vitamin]] [[deficiencies]] in [[blood]] sample<ref name="pmid21569549">{{cite journal| author=Shah I, James R, Barker J, Petroczi A, Naughton DP| title=Misleading measures in Vitamin D analysis: a novel LC-MS/MS assay to account for epimers and isobars. | journal=Nutr J | year= 2011 | volume= 10 | issue= | pages= 46 | pmid=21569549 | doi=10.1186/1475-2891-10-46 | pmc=3114718 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21569549 }}</ref>. | ||
|T2-weighted MRI of the brain and spinal cord showing new patchy lesions, both enhancing and non-enhancing, disseminated in space and time<ref name="pmid12566545" /> | |[[T2-weighted MRI]] of the [[brain]] and [[spinal cord]] showing new patchy [[lesions]], both [[enhancing]] and [[non-enhancing]], disseminated in space and time<ref name="pmid12566545" /> | ||
|Urinary tract infections, depression, social, vocational and psychological complications<ref name="pmid245075222">{{cite journal| author=Gelfand JM| title=Multiple sclerosis: diagnosis, differential diagnosis, and clinical presentation. | journal=Handb Clin Neurol | year= 2014 | volume= 122 | issue= | pages= 269-90 | pmid=24507522 | doi=10.1016/B978-0-444-52001-2.00011-X | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24507522 }}</ref> | |[[Urinary tract infections]], [[depression]], social, vocational and psychological complications<ref name="pmid245075222">{{cite journal| author=Gelfand JM| title=Multiple sclerosis: diagnosis, differential diagnosis, and clinical presentation. | journal=Handb Clin Neurol | year= 2014 | volume= 122 | issue= | pages= 269-90 | pmid=24507522 | doi=10.1016/B978-0-444-52001-2.00011-X | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24507522 }}</ref> | ||
|- | |- | ||
|'''Antiphospholipid antibody syndrome'''<ref name="pmid10670410">{{cite journal| author=Cuadrado MJ, Khamashta MA, Ballesteros A, Godfrey T, Simon MJ, Hughes GR| title=Can neurologic manifestations of Hughes (antiphospholipid) syndrome be distinguished from multiple sclerosis? Analysis of 27 patients and review of the literature. | journal=Medicine (Baltimore) | year= 2000 | volume= 79 | issue= 1 | pages= 57-68 | pmid=10670410 | doi=10.1097/00005792-200001000-00006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10670410 }}</ref> | |'''[[Antiphospholipid antibody syndrome]]'''<ref name="pmid10670410">{{cite journal| author=Cuadrado MJ, Khamashta MA, Ballesteros A, Godfrey T, Simon MJ, Hughes GR| title=Can neurologic manifestations of Hughes (antiphospholipid) syndrome be distinguished from multiple sclerosis? Analysis of 27 patients and review of the literature. | journal=Medicine (Baltimore) | year= 2000 | volume= 79 | issue= 1 | pages= 57-68 | pmid=10670410 | doi=10.1097/00005792-200001000-00006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10670410 }}</ref> | ||
|Arterial thrombosis (TIA, stroke), venous thrombosis leading to pulmonary embolism and pulmonary hypertension, fetal loss, livedo reticularis, response to anticoagulant therapy | |[[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<ref name="pmid10220649">{{cite journal| author=Espínola-Zavaleta N, Vargas-Barrón J, Colmenares-Galvis T, Cruz-Cruz F, Romero-Cárdenas A, Keirns C | display-authors=etal| title=Echocardiographic evaluation of patients with primary antiphospholipid syndrome. | journal=Am Heart J | year= 1999 | volume= 137 | issue= 5 | pages= 973-8 | pmid=10220649 | doi=10.1016/s0002-8703(99)70424-2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10220649 }}</ref>, hypertension, abnormal localisation of lesion on MRI, positive Coombs test, proteinuria, renal failure | |[[Mitral]] and [[aortic]] [[valvular]] involvement<ref name="pmid10220649">{{cite journal| author=Espínola-Zavaleta N, Vargas-Barrón J, Colmenares-Galvis T, Cruz-Cruz F, Romero-Cárdenas A, Keirns C | display-authors=etal| title=Echocardiographic evaluation of patients with primary antiphospholipid syndrome. | journal=Am Heart J | year= 1999 | volume= 137 | issue= 5 | pages= 973-8 | pmid=10220649 | doi=10.1016/s0002-8703(99)70424-2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10220649 }}</ref>, [[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 <ref name="pmid16420554">{{cite journal| author=Miyakis S, Lockshin MD, Atsumi T, Branch DW, Brey RL, Cervera R | display-authors=etal| title=International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). | journal=J Thromb Haemost | year= 2006 | volume= 4 | issue= 2 | pages= 295-306 | pmid=16420554 | doi=10.1111/j.1538-7836.2006.01753.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16420554 }}</ref> | |[[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 <ref name="pmid16420554">{{cite journal| author=Miyakis S, Lockshin MD, Atsumi T, Branch DW, Brey RL, Cervera R | display-authors=etal| title=International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). | journal=J Thromb Haemost | year= 2006 | volume= 4 | issue= 2 | pages= 295-306 | pmid=16420554 | doi=10.1111/j.1538-7836.2006.01753.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16420554 }}</ref> | ||
|Skin ulcerations, thrombocytopenia<ref name="pmid11953980">{{cite journal| author=Cervera R, Piette JC, Font J, Khamashta MA, Shoenfeld Y, Camps MT | display-authors=etal| title=Antiphospholipid syndrome: clinical and immunologic manifestations and patterns of disease expression in a cohort of 1,000 patients. | journal=Arthritis Rheum | year= 2002 | volume= 46 | issue= 4 | pages= 1019-27 | pmid=11953980 | doi=10.1002/art.10187 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11953980 }}</ref>, hemolytic anemia, sudden visual loss/ deafness | |[[Skin]] [[ulcerations]], [[thrombocytopenia]]<ref name="pmid11953980">{{cite journal| author=Cervera R, Piette JC, Font J, Khamashta MA, Shoenfeld Y, Camps MT | display-authors=etal| title=Antiphospholipid syndrome: clinical and immunologic manifestations and patterns of disease expression in a cohort of 1,000 patients. | journal=Arthritis Rheum | year= 2002 | volume= 46 | issue= 4 | pages= 1019-27 | pmid=11953980 | doi=10.1002/art.10187 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11953980 }}</ref>, [[hemolytic]] [[anemia]], sudden [[visual]] loss/ [[deafness]] | ||
|} | |} | ||
Latest revision as of 11:50, 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
The differential diagnoses of Acute disseminated encephalomyelitis include:
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 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
- ↑ 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.
- ↑ "StatPearls". 2022. PMID 32310354 Check
|pmid=value (help). - ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 6.0 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.