Cysticercosis differential diagnosis: Difference between revisions

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|Coats disease
|[[Coats disease]]
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* Diagnosis made usually between 8-16 years (rarely in adulthood)  
* Diagnosis made usually between 8-16 years (rarely in adulthood)  
* Wide range of symptoms from being asymptomatic to decreased vision and strabismus.
* Wide range of symptoms from being [[asymptomatic]] to [[Decreased visual acuity|decreased vision]] and [[strabismus]].
* Decreased visual acuity at initial presentation has a poor prognosis. <ref name="urlHow to Diagnose and Manage Coats’ Disease">{{cite web |url=https://www.reviewofophthalmology.com/article/how-to-diagnose-and-manage-coatsand8217-disease-42782 |title=How to Diagnose and Manage Coats’ Disease |format= |work= |accessdate=}}</ref>
* [[Decreased visual acuity]] at initial presentation has a poor prognosis. <ref name="urlHow to Diagnose and Manage Coats’ Disease">{{cite web |url=https://www.reviewofophthalmology.com/article/how-to-diagnose-and-manage-coatsand8217-disease-42782 |title=How to Diagnose and Manage Coats’ Disease |format= |work= |accessdate=}}</ref>
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* Fundus examination reveals vascular lesions and exudates.
* [[Fundus (eye)|Fundus examination]] reveals vascular lesions and [[Exudate|exudates]].
* Fluorescein angiography is the best method to visualize the lesions.
* [[Fluorescein angiography]] is the best method to visualize the lesions.
* CT and MRI are reserved for atypical cases.<ref name="urlHow to Diagnose and Manage Coats’ Disease">{{cite web |url=https://www.reviewofophthalmology.com/article/how-to-diagnose-and-manage-coatsand8217-disease-42782 |title=How to Diagnose and Manage Coats’ Disease |format= |work= |accessdate=}}</ref>
* [[CT]] and [[MRI]] are reserved for atypical cases.<ref name="urlHow to Diagnose and Manage Coats’ Disease">{{cite web |url=https://www.reviewofophthalmology.com/article/how-to-diagnose-and-manage-coatsand8217-disease-42782 |title=How to Diagnose and Manage Coats’ Disease |format= |work= |accessdate=}}</ref>
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|Retinal Detachment
|[[Retinal detachment]]
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* Most common presenting symptoms are photophobia and floaters
* Most common presenting symptoms are [[photophobia]] and [[floaters]]
* Visual field defects (described as curtain falling from periphery to the center)<ref name="urlManagement of retinal detachment: a guide for non-ophthalmologists">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2405853/ |title=Management of retinal detachment: a guide for non-ophthalmologists |format= |work= |accessdate=}}</ref>
* [[Visual field defect|Visual field defects]] (described as curtain falling from periphery to the center)<ref name="urlManagement of retinal detachment: a guide for non-ophthalmologists">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2405853/ |title=Management of retinal detachment: a guide for non-ophthalmologists |format= |work= |accessdate=}}</ref>
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* Ophthalmoscope is not reliable in detecting retinal detachment as there might be associated hemorrhage
* [[Ophthalmoscope]] is not reliable in detecting retinal detachment as there might be associated [[hemorrhage]]
* Ultrasound can be used to identify and localize the detachment.<ref name="urlManagement of retinal detachment: a guide for non-ophthalmologists">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2405853/ |title=Management of retinal detachment: a guide for non-ophthalmologists |format= |work= |accessdate=}}</ref>
* [[Ultrasound]] can be used to identify and localize the detachment.<ref name="urlManagement of retinal detachment: a guide for non-ophthalmologists">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2405853/ |title=Management of retinal detachment: a guide for non-ophthalmologists |format= |work= |accessdate=}}</ref>
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|Thyroid Ophthalmopathy
|Thyroid Ophthalmopathy
|The hallmark is Eye protrusion, photophobia, lacrimation and later in the disease, diminished eye motility.<ref name="urlThyroid Ophthalmopathy - EyeWiki">{{cite web |url=http://eyewiki.aao.org/Thyroid_Ophthalmopathy |title=Thyroid Ophthalmopathy - EyeWiki |format= |work= |accessdate=}}</ref>
|The hallmark is [[Exophthalmos|Eye protrusion]], [[photophobia]], [[lacrimation]] and later in the disease, diminished eye motility.<ref name="urlThyroid Ophthalmopathy - EyeWiki">{{cite web |url=http://eyewiki.aao.org/Thyroid_Ophthalmopathy |title=Thyroid Ophthalmopathy - EyeWiki |format= |work= |accessdate=}}</ref>
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* [[Ultrasonography]]: inflamed thickened [[extraocular muscles]].
Ultrasonography: inflamed thickened extraocular muscles.
* [[CT]]: shows [[inflamed]] muscle and free tendon from [[inflammation]]
 
* [[MRI]]: shows periorbital fat expansion, increased water content of the muscles as a result of the [[inflammation]].<ref name="urlThyroid Ophthalmopathy - EyeWiki">{{cite web |url=http://eyewiki.aao.org/Thyroid_Ophthalmopathy |title=Thyroid Ophthalmopathy - EyeWiki |format= |work= |accessdate=}}</ref>
CT: shows inflamed muscle and free tendon from inflammation
 
MRI: shows periorbital fat expansion, increased water content of the muscles as a result of the inflammation.<ref name="urlThyroid Ophthalmopathy - EyeWiki">{{cite web |url=http://eyewiki.aao.org/Thyroid_Ophthalmopathy |title=Thyroid Ophthalmopathy - EyeWiki |format= |work= |accessdate=}}</ref>
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|Retinoblastoma
|[[Retinoblastoma]]
|The most prominent sign is leukocoria, followed by strabismus
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* The most prominent sign is [[leukocoria]], followed by [[strabismus]]
The patient also may present with buphthalmos, corneal clouding and eye tearing.<ref name="urlc.ymcdn.com">{{cite web |url=https://c.ymcdn.com/sites/www.covd.org/resource/resmgr/VDR_1-1/VDR1-1_article_Kollodge_Web.pdf+ |title=c.ymcdn.com |format= |work= |accessdate=}}</ref>
* The patient also may present with [[buphthalmos]], [[Cloudy cornea (patient information)|corneal clouding]] and eye tearing.<ref name="urlc.ymcdn.com">{{cite web |url=https://c.ymcdn.com/sites/www.covd.org/resource/resmgr/VDR_1-1/VDR1-1_article_Kollodge_Web.pdf+ |title=c.ymcdn.com |format= |work= |accessdate=}}</ref>
|Ultrasound: can detect the tumor as a result of the calcifications inside.
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* [[Ultrasound]]: can detect the [[tumor]] as a result of the [[Calcification|calcifications]] inside.
MRI: assess sellar and parasellar regions .. it can also detect extraocular spread of the tumor.<ref name="urlc.ymcdn.com">{{cite web |url=https://c.ymcdn.com/sites/www.covd.org/resource/resmgr/VDR_1-1/VDR1-1_article_Kollodge_Web.pdf+ |title=c.ymcdn.com |format= |work= |accessdate=}}</ref>
* [[MRI|MRI:]] assess [[Sella turcica|sellar]] and [[Parasellar and suprasellar disorders|parasellar]] regions .. it can also detect extraocular spread of the [[tumor]].<ref name="urlc.ymcdn.com">{{cite web |url=https://c.ymcdn.com/sites/www.covd.org/resource/resmgr/VDR_1-1/VDR1-1_article_Kollodge_Web.pdf+ |title=c.ymcdn.com |format= |work= |accessdate=}}</ref>


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Revision as of 06:06, 16 April 2017

Cysticercosis Microchapters

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Overview

Cysticercosis must be differentiated from other diseases that cause brain and ocular cyst lesions.

Differentiating neurocysticercosis from other brain cyst lesions
Disease Prominent clinical features Lab findings Radiological findings
Neurocysticercosis
  • Parenchymal lesions: Presentation depends on the site and number of lesions.
  • Seizures are the most common presentation. It is mostly focal but can have a secondary generalization.
 Lab findings are nonspecific.
Brain abscess
  • Lumbar puncture is contraindicated but when done, it was variable between patients.
  • Culture from the CT-guided aspirated lesion helps in identifying the causative agent.
Brain tumors
  • CT may be used in localizing the tumor and getting a rough estimate on the dimensions.
  • MRI: Gadolinium-enhanced MRI is the preferred imaging modality for assessing the extension of the tumor and its exact location.[3]
Brain tuberculoma
  • Presentations are usually due to the pressure effect, not the T.B. bacilli.
  • Presenting symptoms and signs in order of occurrence:[4]
  1. Episodes of focal seizures
  2. Signs of increased intracranial pressure
  3. Focal neurologic deficits.
 T.B. should be investigated everywhere else in the body (e.g. peripheral lymphadenopathy, sputum and blood culture)
  • CT: Contrast-enhanced CT scan shows a ring enhancing lesion surrounded by an area of hypodensity (cerebritis) and the resulting mass effect.
  • MRI: Better than CT scan in assessing the site and size of the tuberculoma. Gadolinium-enhanced MRI shows a ring enhancing lesion between 1-5 cm in size (In NCC, the wall is thicker, calcifications are eccentric and the diameter is less than 2 cm)
Neurosarcoidosis 70% of the patients present with the neurological symptoms rather than the presentation of systemic disease. Common presentations are:[5]
  1. Cranial nerve neuropathies: Facial palsy is the most common presentation.
  2. Meningeal involvement: diffuse meningeal inflammation can cause diffuse basilar polyneuropathy in 40% of the patients. with neurosarcoidosis.
  3. Inflammatory spinal cord disease: Inflammatory span usually more than 3 spinal cord segments which helps to differentiate it from Multiple Sclerosis.
  4. Peripheral neuropathy: Asymmetric polyneuropathy or mononeuritis multiplex. It may also manifest as Guillain-Barré syndrome (GBS) like presentation.
  5. HPO axis involvement: may present as diabetes insipidus. More than 50% of the cases have no radiological signs.
 MRI with contrast shows enhancement of the inflamed areas (i.e. cranial nerves, meninges or HPO axis)
Differentiating ocular cysticercosis from other ocular lesions
Disease Prominent clinical feature Radiological findings
Ocular cysticercosis
Coats disease
Retinal detachment
Thyroid Ophthalmopathy The hallmark is Eye protrusion, photophobia, lacrimation and later in the disease, diminished eye motility.[8]
Retinoblastoma

References

  1. ↑ Brouwer MC, Tunkel AR, McKhann GM, van de Beek D (2014). "Brain abscess". N. Engl. J. Med. 371 (5): 447–56. doi:10.1056/NEJMra1301635. PMID 25075836.
  2. ↑ "Brain Abscess — NEJM".
  3. ↑ 3.0 3.1 "Primary Brain Tumors in Adults - American Family Physician".
  4. ↑ "The Journal of Association of Chest Physicians - Tuberculoma of the brain - A diagnostic dilemma: Magnetic resonance spectroscopy a new ray of hope : Download PDF".
  5. ↑ 5.0 5.1 "Neurosarcoidosis".
  6. ↑ 6.0 6.1 "How to Diagnose and Manage Coats' Disease".
  7. ↑ 7.0 7.1 "Management of retinal detachment: a guide for non-ophthalmologists".
  8. ↑ 8.0 8.1 "Thyroid Ophthalmopathy - EyeWiki".
  9. ↑ 9.0 9.1 "c.ymcdn.com".


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