Ischemic stroke differential diagnosis: Difference between revisions

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|style="background: #F5F5F5; padding: 5px;" |✔
|style="background: #F5F5F5; padding: 5px;" |✔
|style="background: #F5F5F5; padding: 5px;" |Leukocytes and protein
|style="background: #F5F5F5; padding: 5px;" |'''↑''' [[Leukocytes]] and [[protein]]
|style="background: #F5F5F5; padding: 5px;" |CSF [[VDRL]]-specifc
|style="background: #F5F5F5; padding: 5px;" |CSF [[VDRL]]-specifc
CSF FTA-Ab -sensitive<ref name="pmid22421697">{{cite journal| author=Ho EL, Marra CM| title=Treponemal tests for neurosyphilis--less accurate than what we thought? | journal=Sex Transm Dis | year= 2012 | volume= 39 | issue= 4 | pages= 298-9 | pmid=22421697 | doi=10.1097/OLQ.0b013e31824ee574 | pmc=3746559 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22421697  }}</ref>
CSF FTA-Ab -sensitive<ref name="pmid22421697">{{cite journal| author=Ho EL, Marra CM| title=Treponemal tests for neurosyphilis--less accurate than what we thought? | journal=Sex Transm Dis | year= 2012 | volume= 39 | issue= 4 | pages= 298-9 | pmid=22421697 | doi=10.1097/OLQ.0b013e31824ee574 | pmc=3746559 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22421697  }}</ref>
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|style="background: #DCDCDC; padding: 5px; text-align: center;" |Conversion disorder  
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Conversion disorder  
|style="background: #F5F5F5; padding: 5px;" |↓
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|style="background: #F5F5F5; padding: 5px;" |Diagnosis of exclusion??
|style="background: #F5F5F5; padding: 5px;" |Diagnosis of exclusion
|style="background: #F5F5F5; padding: 5px;" |✔
|style="background: #F5F5F5; padding: 5px;" |✔
|style="background: #F5F5F5; padding: 5px;" |✔
|style="background: #F5F5F5; padding: 5px;" |✔
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|style="background: #DCDCDC; padding: 5px; text-align: center;" |Electrolyte disturbance
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Electrolyte disturbance
|style="background: #F5F5F5; padding: 5px;" |↓ or '''↑'''
|style="background: #F5F5F5; padding: 5px;" |
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|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
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|style="background: #F5F5F5; padding: 5px;" |Depends on the cause
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|style="background: #DCDCDC; padding: 5px; text-align: center;" |Intracranial neoplasm
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Meningitis or encephalitis
|style="background: #F5F5F5; padding: 5px;" |
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| style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |'''↑''' Leukocytes,
|style="background: #F5F5F5; padding: 5px;" |
 
|style="background: #F5F5F5; padding: 5px;" |
'''↑''' Protein
|style="background: #F5F5F5; padding: 5px;" |
 
|style="background: #F5F5F5; padding: 5px;" |
↓ Glucose
|style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |[[CSF analysis]]<ref><nowiki><ref name="pmid19398286">{{cite journal| author=Carbonnelle E| title=[Laboratory diagnosis of bacterial meningitis: usefulness of various tests for the determination of the etiological agent]. | journal=Med Mal Infect | year= 2009 | volume= 39 | issue= 7-8 | pages= 581-605 | pmid=19398286 | doi=10.1016/j.medmal.2009.02.017 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19398286  }}</ref></nowiki></ref>
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|style="background: #DCDCDC; padding: 5px; text-align: center;" |Meningitis or encephalitis
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |[[CSF analysis]]<ref><ref name="pmid19398286">{{cite journal| author=Carbonnelle E| title=[Laboratory diagnosis of bacterial meningitis: usefulness of various tests for the determination of the etiological agent]. | journal=Med Mal Infect | year= 2009 | volume= 39 | issue= 7-8 | pages= 581-605 | pmid=19398286 | doi=10.1016/j.medmal.2009.02.017 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19398286  }}</ref></ref>
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| style="background: #F5F5F5; padding: 5px;" |  ✔
| style="background: #F5F5F5; padding: 5px;" |  ✔
|style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" |✔
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|style="background: #F5F5F5; padding: 5px;" |[[Fever]], Neck
| style="background: #F5F5F5; padding: 5px;" |[[Fever]], Neck


rigidity
rigidity
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|style="background: #DCDCDC; padding: 5px; text-align: center;" |Multiple sclerosis exacerbation
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Multiple sclerosis exacerbation
|style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" |✔
|style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |'''↑'''  levels
|style="background: #F5F5F5; padding: 5px;" |Clinical assesment and [[MRI]] <ref><ref name="pmid8274111">{{cite journal| author=Giang DW, Grow VM, Mooney C, Mushlin AI, Goodman AD, Mattson DH et al.| title=Clinical diagnosis of multiple sclerosis. The impact of magnetic resonance imaging and ancillary testing. Rochester-Toronto Magnetic Resonance Study Group. | journal=Arch Neurol | year= 1994 | volume= 51 | issue= 1 | pages= 61-6 | pmid=8274111 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8274111  }}</ref></ref>
| style="background: #F5F5F5; padding: 5px;" |Clinical assesment and [[MRI]] <ref><nowiki><ref name="pmid8274111">{{cite journal| author=Giang DW, Grow VM, Mooney C, Mushlin AI, Goodman AD, Mattson DH et al.| title=Clinical diagnosis of multiple sclerosis. The impact of magnetic resonance imaging and ancillary testing. Rochester-Toronto Magnetic Resonance Study Group. | journal=Arch Neurol | year= 1994 | volume= 51 | issue= 1 | pages= 61-6 | pmid=8274111 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8274111  }}</ref></nowiki></ref>
|style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" |✔
|style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" |✔
|style="background: #F5F5F5; padding: 5px;" |
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| style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" |✔
|style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" |✔
|style="background: #F5F5F5; padding: 5px;" |History of relapses and remissions
| style="background: #F5F5F5; padding: 5px;" |History of relapses and remissions
|style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
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|style="background: #DCDCDC; padding: 5px; text-align: center;" |Seizure
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Seizure
|style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |↓ or '''↑'''
|style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |Clinical assesment and [[EEG]] <ref name="pmid11385043">{{cite journal| author=Manford M| title=Assessment and investigation of possible epileptic seizures. | journal=J Neurol Neurosurg Psychiatry | year= 2001 | volume= 70 Suppl 2 | issue=  | pages= II3-8 | pmid=11385043 | doi= | pmc=1765557 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11385043  }}</ref>
| style="background: #F5F5F5; padding: 5px;" |Clinical assesment and [[EEG]] <ref name="pmid11385043">{{cite journal| author=Manford M| title=Assessment and investigation of possible epileptic seizures. | journal=J Neurol Neurosurg Psychiatry | year= 2001 | volume= 70 Suppl 2 | issue=  | pages= II3-8 | pmid=11385043 | doi= | pmc=1765557 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11385043  }}</ref>
|style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" |✔
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| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |  ✔
| style="background: #F5F5F5; padding: 5px;" |  ✔
|style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" |✔
|style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" |✔
|style="background: #F5F5F5; padding: 5px;" |History of similar episodes in the past
| style="background: #F5F5F5; padding: 5px;" |History of similar episodes in the past
|style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
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|style="background: #DCDCDC; padding: 5px; text-align: center;" |Hypoglycemia or hyperglycemia
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Hypoglycemia or hyperglycemia
|style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |↓ or '''↑'''
{|
| style="background: #F5F5F5; padding: 5px;" |
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| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |'''↑''' or
| style="background: #F5F5F5; padding: 5px;" |Serum blood [[Glucose-1-phosphate adenylyltransferase|glucose]]
| style="background: #F5F5F5; padding: 5px;" |↓
[[HbA1c]]
|}
| style="background: #F5F5F5; padding: 5px;" |
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| style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |[[HbA1c]]
| style="background: #F5F5F5; padding: 5px;" |
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| style="background: #F5F5F5; padding: 5px;" |  ✔
| style="background: #F5F5F5; padding: 5px;" |  ✔
|style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" |✔
|style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" |✔
|style="background: #F5F5F5; padding: 5px;" |History of [[Diabetes mellitus|diabetes]]
| style="background: #F5F5F5; padding: 5px;" |History of [[Diabetes mellitus|diabetes]]
|style="background: #F5F5F5; padding: 5px;" |[[Palpitation|Palpitations]], sweating
| style="background: #F5F5F5; padding: 5px;" |[[Palpitation|Palpitations]], sweating
|}
|}


Revision as of 16:09, 9 November 2016

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Aysha Anwar, M.B.B.S[2]

Overview

Differential Diagnosis

Diseases Diagnostic tests Physical Examination Symptoms Past medical history Other Findings
Na+, K+, Ca2+ CT /MRI CSF Findings Gold standard test Motor Deficit Sensory deficit Speech or gait? Cranial

nerves

Headache LOC Motor weakness Abnormal sensations
Brain tumour[1] ✔ Cancer cells</ref> MRI ✔ ✔ ✔ ✔ Cachexia
Hemorrhagic stroke ✔ xanthochromia</ref> CT scan without contrast</ref></ref> ✔ ✔ ✔ ✔ ✔ ✔ Hypertension
Subdural hemorrhage ✔ CT scan without contrast[2] ✔ ✔ ✔ ✔ ✔ ✔ Trauma/fall
Neurosyphilis[3][4] ✔ ↑ Leukocytes and protein CSF VDRL-specifc

CSF FTA-Ab -sensitive[5]

✔ ✔ ✔ ✔ ✔ STIs
Complex or atypical migraine Clinical assesment ✔ ✔ Family history of migraine
Conversion disorder Diagnosis of exclusion ✔ ✔ ✔ ✔ ✔ ✔
Electrolyte disturbance ↓ or ↑ Depends on the cause
Meningitis or encephalitis ↑ Leukocytes,

↑ Protein

↓ Glucose

CSF analysis</nowiki></ref> ✔ ✔ Fever, Neck

rigidity

Multiple sclerosis exacerbation ✔ ↑ levels Clinical assesment and MRI </nowiki></ref> ✔ ✔ ✔ ✔ History of relapses and remissions
Seizure ↓ or ↑ Clinical assesment and EEG [6] ✔ ✔ ✔ ✔ History of similar episodes in the past
Hypoglycemia or hyperglycemia ↓ or ↑ Serum blood glucose

HbA1c

✔ ✔ ✔ History of diabetes Palpitations, sweating

References

  1. ↑ Morgenstern LB, Frankowski RF (1999). "Brain tumor masquerading as stroke". J Neurooncol. 44 (1): 47–52. PMID 10582668.
  2. ↑
  3. ↑ Liu LL, Zheng WH, Tong ML, Liu GL, Zhang HL, Fu ZG; et al. (2012). "Ischemic stroke as a primary symptom of neurosyphilis among HIV-negative emergency patients". J Neurol Sci. 317 (1–2): 35–9. doi:10.1016/j.jns.2012.03.003. PMID 22482824.
  4. ↑ Berger JR, Dean D (2014). "Neurosyphilis". Handb Clin Neurol. 121: 1461–72. doi:10.1016/B978-0-7020-4088-7.00098-5. PMID 24365430.
  5. ↑ Ho EL, Marra CM (2012). "Treponemal tests for neurosyphilis--less accurate than what we thought?". Sex Transm Dis. 39 (4): 298–9. doi:10.1097/OLQ.0b013e31824ee574. PMC 3746559. PMID 22421697.
  6. ↑ Manford M (2001). "Assessment and investigation of possible epileptic seizures". J Neurol Neurosurg Psychiatry. 70 Suppl 2: II3–8. PMC 1765557. PMID 11385043.

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