Rabies differential diagnosis: Difference between revisions
(→hhh) |
(→hhh) |
||
Line 71: | Line 71: | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" |Sudden | | style="background: #F5F5F5; padding: 5px; text-align:center" |Sudden | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" | CSF analysis: | | style="background: #F5F5F5; padding: 5px; text-align:center" | CSF analysis: | ||
'''↑''' Leukocytes | |||
'''↑''' Protein | |||
↓ Glucose | |||
| style="background: #F5F5F5; padding: 5px; text-align:center" | | | style="background: #F5F5F5; padding: 5px; text-align:center" | | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" |[[Fever]], [[Neck rigidity|neck]], [[Neck rigidity|rigidity]] | | style="background: #F5F5F5; padding: 5px; text-align:center" |[[Fever]], [[Neck rigidity|neck]], [[Neck rigidity|rigidity]] | ||
Line 104: | Line 107: | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" |Insidious | | style="background: #F5F5F5; padding: 5px; text-align:center" |Insidious | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" |CSF analysis: | | style="background: #F5F5F5; padding: 5px; text-align:center" |CSF analysis: | ||
'''↑''' leukocytes | |||
'''↓''' glucose | |||
'''↑''' protien | |||
| style="background: #F5F5F5; padding: 5px; text-align:center" |MRI is more sensitive and specific | | style="background: #F5F5F5; padding: 5px; text-align:center" |MRI is more sensitive and specific | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" |High grade [[fever]], [[fatigue]],[[nausea]], [[vomiting]] | | style="background: #F5F5F5; padding: 5px; text-align:center" |High grade [[fever]], [[fatigue]],[[nausea]], [[vomiting]] | ||
Line 142: | Line 148: | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" |History of outdoor activity in Northeastern United States. The tick is often still latched to the patient at presentation (often in head and neck area) | | style="background: #F5F5F5; padding: 5px; text-align:center" |History of outdoor activity in Northeastern United States. The tick is often still latched to the patient at presentation (often in head and neck area) | ||
|- | |- | ||
! style="background: #DCDCDC; padding: 5px; text-align: center;" | | ! style="background: #DCDCDC; padding: 5px; text-align: center;" | [[Botulism]] | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" | | | style="background: #F5F5F5; padding: 5px; text-align:center" | | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" | | | style="background: #F5F5F5; padding: 5px; text-align:center" | | ||
Line 163: | Line 169: | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" |Possible [[arrhythmia]] | | style="background: #F5F5F5; padding: 5px; text-align:center" |Possible [[arrhythmia]] | ||
|- | |- | ||
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Tetrodotoxin]] | ! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Tetrodotoxin|Tetrodotoxin poisoning]] | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" | | | style="background: #F5F5F5; padding: 5px; text-align:center" | | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" | | | style="background: #F5F5F5; padding: 5px; text-align:center" | | ||
Line 183: | Line 189: | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" |[[Confusion]], [[seizure]], [[Palpitation|palpitations]], [[sweating]], [[dizziness]], [[hypoglycemia]] | | style="background: #F5F5F5; padding: 5px; text-align:center" |[[Confusion]], [[seizure]], [[Palpitation|palpitations]], [[sweating]], [[dizziness]], [[hypoglycemia]] | ||
|- | |- | ||
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Drug toxicity]]/Neuroleptic malignant syndrome | ! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Drug toxicity]]/[[Neuroleptic malignant syndrome]] | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" | - | | style="background: #F5F5F5; padding: 5px; text-align:center" | - | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" | - | | style="background: #F5F5F5; padding: 5px; text-align:center" | - | ||
Line 189: | Line 195: | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" | + | | style="background: #F5F5F5; padding: 5px; text-align:center" | + | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" | | | style="background: #F5F5F5; padding: 5px; text-align:center" | | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" | | | style="background: #F5F5F5; padding: 5px; text-align:center" |Elevated serum [[Creatine kinase|creatine kianse]] | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" | | |||
Hypocalcemia, hypomagnesemia, hypo and hypernatremia, hyperkalemia, and metabolic acidosis | |||
| style="background: #F5F5F5; padding: 5px; text-align:center" |Generalized slow wave EEG | |||
| style="background: #F5F5F5; padding: 5px; text-align:center" |Causative medications (eg, neuroleptics, antiemetics, concomitant lithium), dopaminergic withdrawal, elevated creatine kinase | | style="background: #F5F5F5; padding: 5px; text-align:center" |Causative medications (eg, neuroleptics, antiemetics, concomitant lithium), dopaminergic withdrawal, elevated creatine kinase | ||
Mental status change, rigidity, fever, or dysautonomia | |||
|- | |- | ||
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Organophosphate poisoning|Organophosphate toxicity]] | ! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Organophosphate poisoning|Organophosphate toxicity]] | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" | | | style="background: #F5F5F5; padding: 5px; text-align:center" |- | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" | | | style="background: #F5F5F5; padding: 5px; text-align:center" |- | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" | | | style="background: #F5F5F5; padding: 5px; text-align:center" |- | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" | | | style="background: #F5F5F5; padding: 5px; text-align:center" |+ | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" |Sudden | | style="background: #F5F5F5; padding: 5px; text-align:center" |Sudden | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" | Clinical suspicion confirmed with RBC AchE activity | | style="background: #F5F5F5; padding: 5px; text-align:center" | Clinical suspicion confirmed with RBC AchE activity | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" | | | style="background: #F5F5F5; padding: 5px; text-align:center" |- | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" |History of exposure to i[[Insecticide|nsecticide]] or living in farming environment. with : [[Diarrhea]], [[Urination]], [[Miosis]], [[Bradycardia]], [[Lacrimation]], [[Emesis]], [[Salivation]], [[Sweating]] | | style="background: #F5F5F5; padding: 5px; text-align:center" |History of exposure to i[[Insecticide|nsecticide]] or living in farming environment. with : [[Diarrhea]], [[Urination]], [[Miosis]], [[Bradycardia]], [[Lacrimation]], [[Emesis]], [[Salivation]], [[Sweating]] | ||
|- | |- | ||
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Stroke|Ischemic stroke]] | ! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Stroke|Ischemic stroke]] | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" | | | style="background: #F5F5F5; padding: 5px; text-align:center" |- | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" | | | style="background: #F5F5F5; padding: 5px; text-align:center" |- | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" | | | style="background: #F5F5F5; padding: 5px; text-align:center" |+/- | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" | | | style="background: #F5F5F5; padding: 5px; text-align:center" |+ | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" |Sudden | | style="background: #F5F5F5; padding: 5px; text-align:center" |Sudden | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" | | | style="background: #F5F5F5; padding: 5px; text-align:center" | - | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" |MRI | | style="background: #F5F5F5; padding: 5px; text-align:center" |MRI for ischemia | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" |Sudden unilateral motor and sensory deficit in a patient with a history of [[Atherosclerosis|atherosclero]]<nowiki/>tic risk factors (diabetes, hypertension, smoking) or [[Atrial fibrillation|atrial fibrillation.]] | | style="background: #F5F5F5; padding: 5px; text-align:center" |Sudden unilateral motor and sensory deficit in a patient with a history of [[Atherosclerosis|atherosclero]]<nowiki/>tic risk factors (diabetes, hypertension, smoking) or [[Atrial fibrillation|atrial fibrillation.]] | ||
|- | |- | ||
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Hemorrhagic stroke]] | ! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Hemorrhagic stroke]] | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" | | | style="background: #F5F5F5; padding: 5px; text-align:center" |- | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" | | | style="background: #F5F5F5; padding: 5px; text-align:center" |- | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" | + | | style="background: #F5F5F5; padding: 5px; text-align:center" | + | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" | + | | style="background: #F5F5F5; padding: 5px; text-align:center" | + | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" |Sudden | | style="background: #F5F5F5; padding: 5px; text-align:center" |Sudden | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" | - | | style="background: #F5F5F5; padding: 5px; text-align:center" | - | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" |CT scan | | style="background: #F5F5F5; padding: 5px; text-align:center" |CT scan without contrast | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" |[[Neck stiffness]] | | style="background: #F5F5F5; padding: 5px; text-align:center" |[[Neck stiffness]] | ||
|- | |- | ||
! style="background: #DCDCDC; padding: 5px; text-align:center;" |[[Subdural hematoma|Subdural hemorrhage]] | ! style="background: #DCDCDC; padding: 5px; text-align:center;" |[[Subdural hematoma|Subdural hemorrhage]] | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" | | | style="background: #F5F5F5; padding: 5px; text-align:center" |- | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" | | | style="background: #F5F5F5; padding: 5px; text-align:center" |- | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" | + | | style="background: #F5F5F5; padding: 5px; text-align:center" | + | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" | + | | style="background: #F5F5F5; padding: 5px; text-align:center" | + | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" |Sudden | | style="background: #F5F5F5; padding: 5px; text-align:center" |Sudden | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" |CSF analysis: | | style="background: #F5F5F5; padding: 5px; text-align:center" |CSF analysis: | ||
Xanthochromia | |||
| style="background: #F5F5F5; padding: 5px; text-align:center" |CT scan | | style="background: #F5F5F5; padding: 5px; text-align:center" |CT scan without contrast | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" |[[Confusion]], [[dizziness]], [[nausea]], [[vomiting]] | | style="background: #F5F5F5; padding: 5px; text-align:center" |[[Confusion]], [[dizziness]], [[nausea]], [[vomiting]] | ||
|- | |- | ||
Line 240: | Line 249: | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" | + | | style="background: #F5F5F5; padding: 5px; text-align:center" | + | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" |Sudden | | style="background: #F5F5F5; padding: 5px; text-align:center" |Sudden | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" | | | style="background: #F5F5F5; padding: 5px; text-align:center" |- | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" | - | | style="background: #F5F5F5; padding: 5px; text-align:center" | - | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" |[[Delirium]], [[cortical blindness]], [[cerebral edema]], [[seizure]] | | style="background: #F5F5F5; padding: 5px; text-align:center" |[[Delirium]], [[cortical blindness]], [[cerebral edema]], [[seizure]] | ||
Line 250: | Line 259: | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" | + | | style="background: #F5F5F5; padding: 5px; text-align:center" | + | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" |Sudden | | style="background: #F5F5F5; padding: 5px; text-align:center" |Sudden | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" | | | style="background: #F5F5F5; padding: 5px; text-align:center" |- | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" | - | | style="background: #F5F5F5; padding: 5px; text-align:center" | - | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" |[[Ophthalmoplegia]], [[confusion]] | | style="background: #F5F5F5; padding: 5px; text-align:center" |[[Ophthalmoplegia]], [[confusion]] | ||
|- | |- | ||
! style="background: #DCDCDC; padding: 5px; text-align: center | ! style="background: #DCDCDC; padding: 5px; text-align:center" |[[Amyotrophic lateral sclerosis]] | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" | - | | style="background: #F5F5F5; padding: 5px; text-align:center" | - | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" | | style="background: #F5F5F5; padding: 5px; text-align:center" |- | ||
|- | | style="background: #F5F5F5; padding: 5px; text-align:center" |+/- | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" |+/- | |||
| style="background: #F5F5F5; padding: 5px; text-align:center" | | |||
| style="background: #F5F5F5; padding: 5px; text-align:center" | | |||
| style="background: #F5F5F5; padding: 5px; text-align:center" |Insidious | | style="background: #F5F5F5; padding: 5px; text-align:center" |Insidious | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" | Normal [[Lumbar puncture|LP]] (to rule out DDx) | | style="background: #F5F5F5; padding: 5px; text-align:center" | Normal [[Lumbar puncture|LP]] (to rule out DDx) | ||
Line 277: | Line 273: | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" |Patient initially presents with [[upper motor neuron]] deficit ([[spasticity]]) followed by [[lower motor neuron]] deficit ([[flaccidity]]). | | style="background: #F5F5F5; padding: 5px; text-align:center" |Patient initially presents with [[upper motor neuron]] deficit ([[spasticity]]) followed by [[lower motor neuron]] deficit ([[flaccidity]]). | ||
|- | |- | ||
! style="background: #DCDCDC; padding: 5px; text-align:center;" |Diffuse | ! style="background: #DCDCDC; padding: 5px; text-align:center;" |[[Diffuse gliomatosis]] | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" | | | style="background: #F5F5F5; padding: 5px; text-align:center" |- | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" | | | style="background: #F5F5F5; padding: 5px; text-align:center" |- | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" | | | style="background: #F5F5F5; padding: 5px; text-align:center" |+ | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" | | | style="background: #F5F5F5; padding: 5px; text-align:center" |- | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" |Insidious | | style="background: #F5F5F5; padding: 5px; text-align:center" |Insidious | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" | | | style="background: #F5F5F5; padding: 5px; text-align:center" |Specific molecular characteristics | ||
Normal CSF | Normal CSF | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" |MRI (expansile, T2 hyperintense lesion) | | style="background: #F5F5F5; padding: 5px; text-align:center" |MRI (expansile, T2 hyperintense lesion) | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" | | | style="background: #F5F5F5; padding: 5px; text-align:center" |Seizures, memory loss, motor weakness, visual symptoms, language deficit, and cognitive and personality changes. | ||
|- | |- | ||
! style="background: #DCDCDC; padding: 5px; text-align:center;" | | ! style="background: #DCDCDC; padding: 5px; text-align:center;" |[[Brain tumor|Central nervous system lymphoma]] | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" | | | style="background: #F5F5F5; padding: 5px; text-align:center" |+ | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" | | | style="background: #F5F5F5; padding: 5px; text-align:center" |- | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" | | | style="background: #F5F5F5; padding: 5px; text-align:center" |+ | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" | | | style="background: #F5F5F5; padding: 5px; text-align:center" |+/- | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" |Insidious | | style="background: #F5F5F5; padding: 5px; text-align:center" |Insidious | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" |CSF cytology, flow cytometry, and stereotactic brain biopsy | | style="background: #F5F5F5; padding: 5px; text-align:center" |CSF cytology, flow cytometry, and stereotactic brain biopsy | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" |MRI (parenchymal or leptomeningeal enhancement) | | style="background: #F5F5F5; padding: 5px; text-align:center" |MRI (parenchymal or leptomeningeal enhancement) | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" | | | style="background: #F5F5F5; padding: 5px; text-align:center" |Associated with immunodeficiency | ||
focal neurological deficits, neuropsychiatric symptoms, signs of raised intracranial pressure, seizures, and ocular symptoms | |||
|- | |- | ||
|} | |} |
Revision as of 22:36, 27 September 2017
Rabies Microchapters |
Diagnosis |
---|
Treatment |
Case Studies |
Rabies differential diagnosis On the Web |
American Roentgen Ray Society Images of Rabies differential diagnosis |
Risk calculators and risk factors for Rabies differential diagnosis |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
The differential diagnosis for rabies deals with eliminating diseases with similar symptoms from the diagnosis. There are many viruses that can appear similar to rabies such as encephalitis and the herpes simplex virus. It is very important to rule out certain diseases such as echovirus and poliovirus. Rabies is a serious disease that needs to be treated quickly if someone is suspected to be infected with the virus.
Differentiating Rabies from other Diseases
The differential diagnosis in a case of suspected human rabies may initially include any cause of
Differentiating symptomatic rabies from other diseases that decrease consciousness
- Encephalitis
- Particularly infection with viruses such as:
- The most important viruses to rule out are:
- Herpes simplex virus type 1
- Varicella-zoster virus
- (Less commonly) Enteroviruses including:
- Coxsackieviruses
- Echoviruses
- Polioviruses
- Human enteroviruses 68 to 71.
- A specific diagnosis may be made by a variety of diagnostic techniques, including:
- Polymerase chain reaction (PCR) testing of:
- Cerebrospinal fluid
- viral culture
- Serology.
- In addition, consideration should be given to the local epidemiology of encephalitis caused by arboviruses belonging to several taxonomic groups, including:
New causes of viral encephalitis are also possible, as was evidenced by the recent outbreak in Malaysia of some 300 cases of encephalitis (mortality rate, 40%) caused by Nipah virus, a newly recognized paramyxovirus. Similarly, well-known viruses may be introduced into new locations, as is illustrated by the recent outbreak of encephalitis due to West Nile virus in the eastern United States. Epidemiologic factors (e.g., season, geographic location, and the patient’s age, travel history, and possible exposure to animal bites, rodents, and ticks) may help direct the diagnostic workup.
hhh
Diseases | History and Physical | Diagnostic tests | Other Findings | |||||
---|---|---|---|---|---|---|---|---|
Prodromal symptoms | Fever | Headache | LOC | Neuro Onset | Laboratory Findings | Imaging preferance | ||
Rabies infection | + | + | + | + | Insidious | Hydrophobia, aerophobia, dysphagia, and localized pain, weakness or paresthesias | ||
Meningitis | + | + | + | - | Sudden | CSF analysis:
↑ Leukocytes ↑ Protein ↓ Glucose |
Fever, neck, rigidity | |
encephalitis | + | + | Accompany a meningoencephalitis, seizures, hemiparesis, cranial nerve palsies, photophobia, nausea | |||||
Autoimmune encephalitis | - | +/- | + | +/- | Insidious | Memory deficit, dyskinesias, seizures, autonomic instability | ||
CNS abscess | + | + | + | + | Insidious | CSF analysis:
↑ leukocytes ↓ glucose ↑ protien |
MRI is more sensitive and specific | High grade fever, fatigue,nausea, vomiting |
Poliomyelitis | Sudden | PCR of CSF | Asymmetric paralysis following a flu-like syndrome. | |||||
Neurosyphilis | Insidious | CSF VDRL-specifc
CSF FTA-Ab -sensitive |
MRI & Lumbar puncture | History of unprotected sex or multiple sexual partners, and genital ulcer (chancre)
Blindness, confusion, depression, abnormal gait | ||||
Tick paralysis (Dermacentor tick) | + | Insidious | - | - | History of outdoor activity in Northeastern United States. The tick is often still latched to the patient at presentation (often in head and neck area) | |||
Botulism | Sudden | Toxin test, Blood, Wound, or Stool culture | Diplopia, Hyporeflexia, Hypotonia, possible respiratory paralysis, Floppy baby syndrome | |||||
Electrolyte disturbance | Insidious | Electrolyte panel:
↓Ca++, ↓Mg++, ↓K+ |
Possible arrhythmia | |||||
Tetrodotoxin poisoning | Sudden | - | - | History of consumption of puffer fish species. | ||||
Metabolic disturbances (electrolyte imbalance, hypoglycemia) | - | +/- | - | + | Sudden | Hypoglycemia, hypo and hypernatremia, hypo and hyperkalemia | Confusion, seizure, palpitations, sweating, dizziness, hypoglycemia | |
Drug toxicity/Neuroleptic malignant syndrome | - | - | - | + | Elevated serum creatine kianse
Hypocalcemia, hypomagnesemia, hypo and hypernatremia, hyperkalemia, and metabolic acidosis |
Generalized slow wave EEG | Causative medications (eg, neuroleptics, antiemetics, concomitant lithium), dopaminergic withdrawal, elevated creatine kinase
Mental status change, rigidity, fever, or dysautonomia | |
Organophosphate toxicity | - | - | - | + | Sudden | Clinical suspicion confirmed with RBC AchE activity | - | History of exposure to insecticide or living in farming environment. with : Diarrhea, Urination, Miosis, Bradycardia, Lacrimation, Emesis, Salivation, Sweating |
Ischemic stroke | - | - | +/- | + | Sudden | - | MRI for ischemia | Sudden unilateral motor and sensory deficit in a patient with a history of atherosclerotic risk factors (diabetes, hypertension, smoking) or atrial fibrillation. |
Hemorrhagic stroke | - | - | + | + | Sudden | - | CT scan without contrast | Neck stiffness |
Subdural hemorrhage | - | - | + | + | Sudden | CSF analysis:
Xanthochromia |
CT scan without contrast | Confusion, dizziness, nausea, vomiting |
Hypertensive encephalopathy | - | - | + | + | Sudden | - | - | Delirium, cortical blindness, cerebral edema, seizure |
Wernicke’s encephalopathy | - | - | - | + | Sudden | - | - | Ophthalmoplegia, confusion |
Amyotrophic lateral sclerosis | - | - | +/- | +/- | Insidious | Normal LP (to rule out DDx) | MRI | Patient initially presents with upper motor neuron deficit (spasticity) followed by lower motor neuron deficit (flaccidity). |
Diffuse gliomatosis | - | - | + | - | Insidious | Specific molecular characteristics
Normal CSF |
MRI (expansile, T2 hyperintense lesion) | Seizures, memory loss, motor weakness, visual symptoms, language deficit, and cognitive and personality changes. |
Central nervous system lymphoma | + | - | + | +/- | Insidious | CSF cytology, flow cytometry, and stereotactic brain biopsy | MRI (parenchymal or leptomeningeal enhancement) | Associated with immunodeficiency
focal neurological deficits, neuropsychiatric symptoms, signs of raised intracranial pressure, seizures, and ocular symptoms |