Neurosyphilis differential diagnosis: Difference between revisions

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Latest revision as of 19:03, 9 March 2018

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohamadmostafa Jahansouz M.D.[2]Tarek Nafee, M.D. [3]

Overview

Neurosyphilis must be differentiated from other diseases that cause abnormal gait, Blindness, confusion and depression, such as multiple sclerosis, Brain tumours, Wernicke’s encephalopathy, CNS abscess, electrolyte disturbance, Subdural empyema, subarachnoid hemorrhage, brain stroke, Conversion disorder and Drug toxicity.

Differentiating X from other Diseases

Neuroyphilis has an extensive differential diagnosis.

Neurosyphilis must be differentiated from other diseases that cause abnormal gait, Blindness, confusion and depression, such as multiple sclerosis, Brain tumours, Wernicke’s encephalopathy, CNS abscess, electrolyte disturbance, Subdural empyema, subarachnoid hemorrhage, brain stroke, Conversion disorder and Drug toxicity.^[1]^[2]^[3]^[4]^[5]^[6]^[7]^[8]^[9]^[10]

Diseases	Diagnostic tests				Physical Examination					Symptoms			Past medical history	Other Findings
Diseases	Na+, K+, Ca2+	CT /MRI	CSF Findings	Gold standard test	Neck stiffness	Motor or Sensory deficit	Papilledema	Bulging fontanelle	Cranial nerves	Headache	Fever	Altered mental status	Past medical history	Other Findings
Neurosyphilis^[3]^[4]		✔	↑ Leukocytes and protein	CSF VDRL-specifc CSF FTA-Ab -sensitive^[5]	✔	✔	✔	✔	✔	✔	✔	✔	Unprotected sexual intercourse, STIs History of multiple sexual partners. History of genital ulcer (chancre)	Blindness confusion, epression, Abnormal gait
Multiple sclerosis			Oligoclonal bands of IgG on electrophoresis of cerebrospinal fluid	MRI	✔	✔			✔	✔		✔	History of fatigue Mood problems Spasticity Bowel and bladder dysfunction	Vision problems Balance problems Dizziness Areas of demyelination in CNS MRI
Brain tumour^[1]^[2]		✔	Cancer cells^[7]	MRI		✔	✔	✔	✔	✔		✔		Cachexia Gradual progression of symptoms
Wernicke’s encephalopathy			Normal				✔	✔			✔		History of alcohal abuse	Ophthalmoplegia confusion
CNS abscess		✔	↑ leukocytes >100,000/ul ↓ glucose and ↑ protien ↑ red blood cells lactic acid >500mg	Contrast enhanced MRI is more sensitive and specific Histopathological examination of brain tissue	✔	✔	✔		✔	✔	✔	✔	History of drug abuse endocarditis	High grade fever Fatigue Nausea vomiting
Electrolyte disturbance	↓ or ↑			Depends on the cause						✔		✔		Confusion Seizures
Subdural empyema		✔		Clinical assesment and MRI	✔	✔	✔	✔	✔			✔	History of relapses and remissions	Blurry vision urinary incontinence Fatigue
Delirium tremens		✔		Clinical diagnosis		✔	✔		✔	✔	✔	✔	Alcohol intake Sudden withdraw or reduction in consumption	Tachycardia diaphoresis hypertension tremors, mydriasis Positional Nystagmus,
Subarachnoid hemorrhage^[8]		✔	Xanthochromia^[9]	CT scan without contrast^[11]^[6]	✔	✔	✔	✔	✔	✔	✔	✔	Trauma/fall	Confusion dizziness Nausea Vomiting
Stroke		✔	Normal	CT scan without contrast		✔	✔		✔	✔		✔	TIAs, hypertension, diabetes mellitus	Speech difficulty Gait abnormality
Viral encephalitis		✔	Increased RBCS or xanthochromia Mononuclear lymphocytosis High protein content Normal glucose	Clinical assesment	✔	✔	✔		✔	✔	✔	✔	Tick bite Mosquito bite Viral prodome for several days	Extreme lethargy Rash hepatosplenomegaly lymphadenopathy behavioural changes
Herpes simplex encephalitis		✔		Clinical assesment			✔	✔	✔	✔	✔		History of hypertension	Delirium Cortical blindness cerebral edema seizure
Drug toxicity											✔	✔		Lithium Sedatives phenytoin carbamazepine
Conversion disorder				Diagnosis of exclusion		✔		✔		✔	✔	✔		Tremors blindness Difficulty swallowing
Febrile convulsion			Not performed in first simple febrile seizures	Clinical diagnosis and EEG					✔	✔	✔	✔	Family history of febrile seizures Family history of gastroenteritis Family history of viral illness or	Age > 1 month,
Hypoglycemia	↓ or ↑			Serum glucose HbA1c		✔				✔		✔	History of diabetes	Palpitations sweating dizziness Low serum glucose

References

↑ ^1.0 ^1.1 Soffer D (1976) Brain tumors simulating purulent meningitis. Eur Neurol 14 (3):192-7. PMID: 1278192
↑ ^2.0 ^2.1
↑ ^3.0 ^3.1 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.
↑ ^4.0 ^4.1 Berger JR, Dean D (2014). "Neurosyphilis". Handb Clin Neurol. 121: 1461–72. doi:10.1016/B978-0-7020-4088-7.00098-5. PMID 24365430.
↑ ^5.0 ^5.1 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.
↑ ^6.0 ^6.1 DeLaPaz RL, Wippold FJ, Cornelius RS, Amin-Hanjani S, Angtuaco EJ, Broderick DF; et al. (2011). "ACR Appropriateness Criteria® on cerebrovascular disease". J Am Coll Radiol. 8 (8): 532–8. doi:10.1016/j.jacr.2011.05.010. PMID 21807345.
↑ ^7.0 ^7.1 Weston CL, Glantz MJ, Connor JR (2011). "Detection of cancer cells in the cerebrospinal fluid: current methods and future directions". Fluids Barriers CNS. 8 (1): 14. doi:10.1186/2045-8118-8-14. PMC 3059292. PMID 21371327.
↑ ^8.0 ^8.1 Yeh ST, Lee WJ, Lin HJ, Chen CY, Te AL, Lin HJ (2003) Nonaneurysmal subarachnoid hemorrhage secondary to tuberculous meningitis: report of two cases. J Emerg Med 25 (3):265-70. PMID: 14585453
↑ ^9.0 ^9.1 Lee MC, Heaney LM, Jacobson RL, Klassen AC (1975). "Cerebrospinal fluid in cerebral hemorrhage and infarction". Stroke. 6 (6): 638–41. PMID 1198628.
↑ Goldenberg MM (2012). "Multiple sclerosis review". P T. 37 (3): 175–84. PMC 3351877. PMID 22605909.
↑ Birenbaum D, Bancroft LW, Felsberg GJ (2011). "Imaging in acute stroke". West J Emerg Med. 12 (1): 67–76. PMC 3088377. PMID 21694755.

Template:WH Template:WS

[pmid1278192-1] 1.0 ^1.1 Soffer D (1976) Brain tumors simulating purulent meningitis. Eur Neurol 14 (3):192-7. PMID: 1278192

[pmid3883130-2] 2.0 ^2.1

[pmid22482824-3] 3.0 ^3.1 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.

[pmid24365430-4] 4.0 ^4.1 Berger JR, Dean D (2014). "Neurosyphilis". Handb Clin Neurol. 121: 1461–72. doi:10.1016/B978-0-7020-4088-7.00098-5. PMID 24365430.

[pmid22421697-5] 5.0 ^5.1 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.

[pmid21807345-6] 6.0 ^6.1 DeLaPaz RL, Wippold FJ, Cornelius RS, Amin-Hanjani S, Angtuaco EJ, Broderick DF; et al. (2011). "ACR Appropriateness Criteria® on cerebrovascular disease". J Am Coll Radiol. 8 (8): 532–8. doi:10.1016/j.jacr.2011.05.010. PMID 21807345.

[pmid21371327-7] 7.0 ^7.1 Weston CL, Glantz MJ, Connor JR (2011). "Detection of cancer cells in the cerebrospinal fluid: current methods and future directions". Fluids Barriers CNS. 8 (1): 14. doi:10.1186/2045-8118-8-14. PMC 3059292. PMID 21371327.

[pmid14585453-8] 8.0 ^8.1 Yeh ST, Lee WJ, Lin HJ, Chen CY, Te AL, Lin HJ (2003) Nonaneurysmal subarachnoid hemorrhage secondary to tuberculous meningitis: report of two cases. J Emerg Med 25 (3):265-70. PMID: 14585453

[pmid1198628-9] 9.0 ^9.1 Lee MC, Heaney LM, Jacobson RL, Klassen AC (1975). "Cerebrospinal fluid in cerebral hemorrhage and infarction". Stroke. 6 (6): 638–41. PMID 1198628.

[pmid22605909-10] Goldenberg MM (2012). "Multiple sclerosis review". P T. 37 (3): 175–84. PMC 3351877. PMID 22605909.

[pmid21694755-11] Birenbaum D, Bancroft LW, Felsberg GJ (2011). "Imaging in acute stroke". West J Emerg Med. 12 (1): 67–76. PMC 3088377. PMID 21694755.

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@@ Line 4: / Line 4: @@
 ==Overview==
-Neurosyphilis must be differentiated from other diseases that cause abnormal [[gait]], [[Blindness]], [[confusion]] and [[depression]], such as [[multiple sclerosis]], [[Brain tumour]]<nowiki/>s, Wernicke’s encephalopathy, [[CNS abscess]], [[electrolyte disturbance]], [[Subdural empyema]], [[Subarachnoid hemorrhage|subarachnoid  hemorrhage]], [[Stroke|brain stroke]], [[Conversion disorder]] and [[Drug toxicity]].
+Neurosyphilis must be differentiated from other diseases that cause abnormal [[gait]], [[Blindness]], [[confusion]] and [[depression]], such as [[multiple sclerosis]], [[Brain tumour]]<nowiki/>s, [[Wernicke's encephalopathy|Wernicke’s encephalopathy]], [[CNS abscess]], [[electrolyte disturbance]], [[Subdural empyema]], [[Subarachnoid hemorrhage|subarachnoid  hemorrhage]], [[Stroke|brain stroke]], [[Conversion disorder]] and [[Drug toxicity]].
 ==Differentiating X from other Diseases==
 * Neuroyphilis has an extensive differential diagnosis.
-*Neurosyphilis must be differentiated from other diseases that cause abnormal [[gait]], [[Blindness]], [[confusion]] and [[depression]], such as [[Brain tumour]]<nowiki/>s, Wernicke’s encephalopathy, [[CNS abscess]], [[electrolyte disturbance]], [[Subdural empyema]], [[Subarachnoid hemorrhage|subarachnoid  hemorrhage]], [[Stroke|brain stroke]], [[Conversion disorder]] and [[Drug toxicity]].<ref name="pmid1278192" /><ref name="pmid3883130" /><ref name="pmid22482824" /><ref name="pmid24365430" /><ref name="pmid22421697" /><ref name="pmid21807345" /><ref name="pmid21371327" /><ref name="pmid14585453" /><ref name="pmid1198628" /><ref name="pmid22605909">{{cite journal| author=Goldenberg MM| title=Multiple sclerosis review. | journal=P T | year= 2012 | volume= 37 | issue= 3 | pages= 175-84 | pmid=22605909 | doi= | pmc=3351877 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22605909  }} </ref>
+*Neurosyphilis must be differentiated from other diseases that cause abnormal [[gait]], [[Blindness]], [[confusion]] and [[depression]], such as [[multiple sclerosis]], [[Brain tumour]]<nowiki/>s, [[Wernicke's encephalopathy|Wernicke’s encephalopathy]], [[CNS abscess]], [[electrolyte disturbance]], [[Subdural empyema]], [[Subarachnoid hemorrhage|subarachnoid  hemorrhage]], [[Stroke|brain stroke]], [[Conversion disorder]] and [[Drug toxicity]].<nowiki/><nowiki/><ref name="pmid1278192" /><ref name="pmid3883130" /><ref name="pmid22482824" /><ref name="pmid24365430" /><ref name="pmid22421697" /><ref name="pmid21807345" /><ref name="pmid21371327" /><ref name="pmid14585453" /><ref name="pmid1198628" /><ref name="pmid22605909">{{cite journal| author=Goldenberg MM| title=Multiple sclerosis review. | journal=P T | year= 2012 | volume= 37 | issue= 3 | pages= 175-84 | pmid=22605909 | doi= | pmc=3351877 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22605909  }} </ref>
 {|
 |- style="background: #4479BA; color: #FFFFFF; text-align: center;"
@@ Line 52: / Line 52: @@
 * History of multiple sexual partners.
-* History of [[genital ulcer]] ([[chancre]]), diffuse [[Maculopapular rash|maculopapular ras]]<nowiki/>h.
+* History of [[genital ulcer]] ([[chancre]])
 | style="background: #F5F5F5; padding: 5px;" |
 * [[Blindness]]
 * [[confusion]],
-* [[depression]],
+* [[depression|epression]],
 * Abnormal [[gait]]
@@ Line 98: / Line 98: @@
 | style="background: #F5F5F5; padding: 5px;" |✔
 | style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |[[Cachexia]], gradual progression of symptoms
+| style="background: #F5F5F5; padding: 5px;" |
+* [[Cachexia]]
+* Gradual progression of symptoms
 |-
 | style="background: #DCDCDC; padding: 5px; text-align: center;" |Wernicke’s encephalopathy
@@ Line 114: / Line 116: @@
 | style="background: #F5F5F5; padding: 5px;" |
 | style="background: #F5F5F5; padding: 5px;" |History of alcohal abuse
-| style="background: #F5F5F5; padding: 5px;" |[[Ophthalmoplegia]], [[confusion]]
+| style="background: #F5F5F5; padding: 5px;" |
+* [[Ophthalmoplegia]]
+* [[confusion]]
 |-
 | style="background: #DCDCDC; padding: 5px; text-align: center;" |[[CNS abscess]]
 | style="background: #F5F5F5; padding: 5px;" |
 | style="background: #F5F5F5; padding: 5px;" |✔
-| style="background: #F5F5F5; padding: 5px;" |'''↑''' [[leukocytes]] >100,000/ul, '''↓''' [[glucose]] and '''↑''' protien, '''↑''' red blood cells, [[lactic acid]] >500mg
+| style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |Contrast enhanced MRI is more sensitive and specific,
+* '''↑''' [[leukocytes]] >100,000/ul
-[[Histopathological]] examination of brain tissue
+* '''↓''' [[glucose]] and '''↑''' protien
+* '''↑''' red blood cells
+* [[lactic acid]] >500mg
+| style="background: #F5F5F5; padding: 5px;" |
+* Contrast enhanced MRI is more sensitive and specific
+* [[Histopathological]] examination of brain tissue
 | style="background: #F5F5F5; padding: 5px;" |✔
 | style="background: #F5F5F5; padding: 5px;" |✔
@@ Line 130: / Line 141: @@
 | style="background: #F5F5F5; padding: 5px;" |✔
 | style="background: #F5F5F5; padding: 5px;" |✔
-| style="background: #F5F5F5; padding: 5px;" |History of [[drug abuse]], [[endocarditis]], '''↓''' [[immune]] status
+| style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |High grade [[fever]], [[fatigue]],[[Nausea and vomiting|nausea]], [[vomiting]]
+* History of [[drug abuse]]
+* [[endocarditis]]
+| style="background: #F5F5F5; padding: 5px;" |
+* High grade [[fever]]
+* F[[fatigue|atigue]]
+* N[[Nausea and vomiting|ausea]]
+* [[vomiting]]
 |-
 | style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Electrolyte disturbance]]
@@ Line 147: / Line 164: @@
 | style="background: #F5F5F5; padding: 5px;" |✔
 | style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |[[Confusion]], [[Seizure|seizures]]
+| style="background: #F5F5F5; padding: 5px;" |
+* [[Confusion]]
+* S[[Seizure|eizures]]
 |-
 | style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Subdural empyema]]
@@ Line 163: / Line 182: @@
 | style="background: #F5F5F5; padding: 5px; text-align:center" |✔
 | style="background: #F5F5F5; padding: 5px;" |History of relapses and remissions
-| style="background: #F5F5F5; padding: 5px;" |Blurry vision, [[urinary incontinence]], [[fatigue]]
+| style="background: #F5F5F5; padding: 5px;" |
+* Blurry vision
+* [[urinary incontinence]]
+* F[[fatigue|atigue]]
 |-
 | style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Delirium tremens]]
@@ Line 178: / Line 201: @@
 | style="background: #F5F5F5; padding: 5px; text-align:center" |✔
 | style="background: #F5F5F5; padding: 5px; text-align:center" |✔
-| style="background: #F5F5F5; padding: 5px;" |[[Alcohol]] intake, sudden witdrawl or reduction in consumption
+| style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |[[Tachycardia]], [[diaphoresis]], [[hypertension]], [[tremors]], [[mydriasis]], [[positional nystagmus]],
+* [[Alcohol]] intake
+* Sudden withdraw or reduction in consumption
+| style="background: #F5F5F5; padding: 5px;" |
+* [[Tachycardia]]
+* [[diaphoresis]]
+* [[hypertension]]
+* [[tremors]],
+* [[mydriasis]]
+* [[positional nystagmus|Positional Nystagmus]],
 |-
 | style="background: #DCDCDC; padding: 5px; text-align: center;" | [[Subarachnoid hemorrhage|Subarachnoid  hemorrhage]]<ref name="pmid14585453">Yeh ST, Lee WJ, Lin HJ, Chen CY, Te AL, Lin HJ (2003) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=14585453 Nonaneurysmal subarachnoid hemorrhage secondary to tuberculous meningitis: report of two cases.] ''J Emerg Med'' 25 (3):265-70. PMID: [http://pubmed.gov/14585453 14585453]</ref>
@@ Line 196: / Line 228: @@
 | style="background: #F5F5F5; padding: 5px; text-align:center" |✔
 | style="background: #F5F5F5; padding: 5px;" |Trauma/fall
-| style="background: #F5F5F5; padding: 5px;" |[[Confusion]], [[dizziness]], [[Nausea and vomiting|nausea]], [[Nausea and vomiting|vomiting]]
+| style="background: #F5F5F5; padding: 5px;" |
+* [[Confusion]]
+* [[dizziness]]
+* [[Nausea and vomiting|Nausea]]
+* [[Nausea and vomiting|Vomiting]]
 |-
 | style="background: #DCDCDC; padding: 5px; text-align: center;" | [[Stroke]]
@@ Line 212: / Line 248: @@
 | style="background: #F5F5F5; padding: 5px; text-align:center" |✔
 | style="background: #F5F5F5; padding: 5px; text-align:center" |TIAs, [[hypertension]], [[diabetes mellitus]]
-| style="background: #F5F5F5; padding: 5px; text-align:center" |Speech difficulty, gait abnormality
+| style="background: #F5F5F5; padding: 5px; text-align:center" |
+* Speech difficulty
+* Gait abnormality
 |-
 | style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Viral encephalitis]]
 | style="background: #F5F5F5; padding: 5px;" |
 | style="background: #F5F5F5; padding: 5px;" |✔
-| style="background: #F5F5F5; padding: 5px;" |Increased [[RBC]]S or xanthochromia, [[Mononuclear cells|mononuclear]] [[lymphocytosis]], high protein content, normal [[glucose]]
+| style="background: #F5F5F5; padding: 5px;" |
+* Increased [[RBC]]S or xanthochromia
+* [[Mononuclear cells|Mononuclear]] [[lymphocytosis]]
+* High protein content
+* Normal [[glucose]]
 | style="background: #F5F5F5; padding: 5px;" |Clinical assesment
 | style="background: #F5F5F5; padding: 5px;" |✔
@@ Line 227: / Line 269: @@
 | style="background: #F5F5F5; padding: 5px;" |✔
 | style="background: #F5F5F5; padding: 5px;" |✔
-| style="background: #F5F5F5; padding: 5px;" |Tick bite/mosquito bite/ viral prodome for several days
+| style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |Extreme lethargy, rash [[hepatosplenomegaly]], [[lymphadenopathy]], [[behavioural]] changes
+* Tick bite
+* Mosquito bite
+* Viral prodome for several days
+| style="background: #F5F5F5; padding: 5px;" |
+* Extreme lethargy
+* Rash
+* [[hepatosplenomegaly]]
+* [[lymphadenopathy]]
+* [[behavioural]] changes
 |-
 | style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Herpes simplex encephalitis]]
@@ Line 244: / Line 294: @@
 | style="background: #F5F5F5; padding: 5px;" |
 | style="background: #F5F5F5; padding: 5px;" |History of [[hypertension]]
-| style="background: #F5F5F5; padding: 5px;" |[[Delirium]], cortical [[blindness]], [[cerebral edema]], [[seizure]]
+| style="background: #F5F5F5; padding: 5px;" |
+* [[Delirium]]
+* Cortical [[blindness]]
+* [[cerebral edema]]
+* [[seizure]]
 |-
 | style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Drug toxicity]]
@@ Line 260: / Line 314: @@
 | style="background: #F5F5F5; padding: 5px;" |✔
 | style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |[[Lithium]], Sedatives, [[phenytoin]], [[carbamazepine]]
+| style="background: #F5F5F5; padding: 5px;" |
+* [[Lithium]]
+* Sedatives
+* [[phenytoin]]
+* [[carbamazepine]]
 |-
 | style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Conversion disorder]]
@@ Line 276: / Line 334: @@
 | style="background: #F5F5F5; padding: 5px; text-align:center" |✔
 | style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |[[Tremor|Tremors]], [[blindness]], difficulty [[swallowing]]
+| style="background: #F5F5F5; padding: 5px;" |
+* [[Tremor|Tremors]]
+* [[blindness]]
+* Difficulty [[swallowing]]
 |-
 | style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Febrile convulsion]]
@@ Line 291: / Line 352: @@
 | style="background: #F5F5F5; padding: 5px;" |✔
 | style="background: #F5F5F5; padding: 5px;" |✔
-| style="background: #F5F5F5; padding: 5px;" |Family history of [[febrile]] [[seizures]], [[viral]] illness or [[gastroenteritis]]
+| style="background: #F5F5F5; padding: 5px;" |
+* Family history of [[febrile]] [[seizures]]
+* Family history of [[gastroenteritis]]
+* Family history of [[viral]] illness or
 | style="background: #F5F5F5; padding: 5px;" |Age > 1 month,
 |-
@@ Line 298: / Line 363: @@
 | style="background: #F5F5F5; padding: 5px;" |
 | style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |Serum blood [[Glucose-1-phosphate adenylyltransferase|glucose]]
+| style="background: #F5F5F5; padding: 5px;" |Serum [[Glucose-1-phosphate adenylyltransferase|glucose]]
 [[HbA1c]]
 | style="background: #F5F5F5; padding: 5px;" |
@@ Line 309: / Line 374: @@
 | style="background: #F5F5F5; padding: 5px;" |✔
 | style="background: #F5F5F5; padding: 5px;" |History of [[Diabetes mellitus|diabetes]]
-| style="background: #F5F5F5; padding: 5px;" |[[Palpitation|Palpitations]], [[sweating]], [[dizziness]], low serum, [[glucose]]
+| style="background: #F5F5F5; padding: 5px;" |
+* [[Palpitation|Palpitations]]
+* [[sweating]]
+* [[dizziness]]
+* Low serum [[glucose]]
 |}

Neurosyphilis differential diagnosis: Difference between revisions

Latest revision as of 19:03, 9 March 2018

Overview

Differentiating X from other Diseases

References

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