Headache differential diagnosis: Difference between revisions

Latest revision as of 21:58, 29 July 2020

For the WikiDoc page for this topic, click here Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sabeeh Islam, MBBS [2]

Differential diagnosis of headache includes: Migraine, tension-type headache, cluster headache, seizure, meningitis, encephalitis, neurosyphilis, SAH, subdural hematoma, brain tumor, hypertensive encephalopathy, brain abscess, multiple sclerosis, hemorrhagic stroke, Wernickes encephalopathy, and drug toxicity etc.^[1]^[2]^[3]^[4]^[5]^[6]^[7]^[8]^[9]^[10]^[11]^[12]^[13]^[14]^[15]^[16]^[17]^[18]^[19]


Disease	History and Physical Examination													PMHx	Diagnostic approach
Disease	Bilateral	Throbbing character	Autonomic symptoms	Fever	Photophobia	Aphasia	LOC	Aura	Nause/ Vomiting	Rash	Neck stiffness	Vision changes	Neurologic deficits	PMHx	Labs and CSF findings	CT/MRI	Gold standard test
Migraine	-	+	-	-	+	-	-	+	+	-	-	+	-	Trigger factors, family hx	-	-	Clinical assesment
Tension-type headache (TTH)	+	-	-	-	-	-	-	-	-	-	-	-	-	stress, genetics	-	-	Clinical assesment
Cluster headache	-	-	+	-	-	-	-	-	-	-	-	+	-	episodic history	-	-	Clinical assesment
Seizure	+	-	-	-	-	+/-	+	+/-	-	-	-	-	+/-	Hx of seizures	prolactin level	+/- mass lesion	EEG ^[20]
Meningitis	+	-	-	+	+/-	+/-	-	-	+/-	+/-	+	-	+	Hx of fever, malaise	<math>\uparrow</math>WBC <math>\uparrow</math>Protein <math>\downarrow</math>glucose	+/-	CSF analysis^[21]
Encephalitis	+	+/-	-	+	+/-	+/-	-	-	-	+/-	+	-	+	Hx of fever, malaise	elevated WBC, low glucose	+	CSF PCR
Brain tumor^[22]	+	-	-	-	-	+/-	-	-	+/-	-	-	+/-	+/-	weight loss, fatigue	neuromarkers, Cancer cells^[23]	+/- mass	MRI
Subdural hemorrhage	-/+	+/-	-	-	-	+/-	-	-	-	-	-	+/-	+/-	Trauma, fall	Xanthochromia	+	CT w/o contrast
Subarachnoid hemorrhage	-/+	+/-	-	-	+/-	+/-	-	-	-	-	+/-	+/-	+/-	thunderclap headache	<math>\uparrow</math>opening pressure, xanthochromia	+	CT w/o contrast
Hypertensive encephalopathy	+	+/-	-	-	+/-	-	-	-	-	-	-	+/-	-	Hypertension	UA +/-	+/-	clinical assessment
CNS abscess	-/+	-	-	+	-	+/-	-	-	+/-	+/-	+/-	+/-	+/-	History of drug abuse, endocarditis, immunosupression	↑ leukocytes, ↓ glucose and ↑ protien	+	MRI
Conversion disorder	-/+	-	-	-	-	+/-	-	-	-	-	+/-	+/-	+/-	History of emotional stress	-	-	Diagnosis of exclusion
Multiple sclerosis	-/+	-	-	-	-	-	-	-	-	-	-	+	+/-	History of relapses and remissions	↑ CSF IgG levels (monoclonal bands)	+	MRI
Hemorrhagic stroke	-/+	+/-	-	-	-	+/-	-	-	-	-	-	+/-	+/-	HTN	-	+	CT scan without contrast^[24]^[25]
Neurosyphilis^[26]^[27]	-/+	-	-	-	-	-	+/-	-	-	+/-	-	+/-	+/-	STIs	↑ Leukocytes and protein	+	CSF VDRL-specifc CSF FTA-Ab -sensitive^[28]
Wernicke’s encephalopathy	-/+	-	-	-	-	+/-	-	-	-	-	-	+/-	+/-	History of alcohal abuse	blood ethanol levels	+/-	Clinical assesment and lab findings
Drug toxicity	-/+	-	-	+/-	-	-	+/-	-	+/-	-	+/-	+/-	+/-	Medication hx	Drug levels	-	Drug screen test
Metabolic disturbances	-/+	-	-	-	-	-	-	-	+/-	-	-	+/-	+/-	Underlying CKD, CLD	Hypoglycemia, hypo and hypernatremia, hypo and hyperkalemia	-	Cause dependent
Sinusitis	-/+	-	-	+/-	-	-	-	-	-	-	-	-	-	allergies, seasonal	leukocytosis	+	CT

Diagnsotic Labs For Meningitis

Diagnosis of meningitis, is based on clinical presentation in combination with CSF analysis. CSF analysis has major role for diagnosis and rule out other possibilities. The following table summarizes the CSF findings in different types of meningitis.^[2]^[3]^[4]^[5]^[6]


Cerebrospinal fluid level	Normal level	Bacterial meningitis^[5]	Viral meningitis^[5]	Fungal meningitis	Tuberculous meningitis^[29]	Neoplastic meningitis^[2]
Cells/ul	< 5	>300	10-1000	10-500	50-500	>4
Cells	Lymphocyte	Leukocyte > Lymphocyte	Lymphocyte > Leukocyte	Lymphocyte > Leukocyte	Lymphocyte > Leukocyte	Lymphocyte > Leukocyte
Total protein (mg/dl)	45-60	Typically 100-500	Normal or slightly high	High	Typically 100-200	>50
Glucose ratio (CSF/plasma)^[3]	> 0.5	< 0.3	> 0.6	<0.3	< 0.5	<0.5
Lactate (mmols/l)^[4]	< 2.1	> 2.1	< 2.1	>3.2	> 2.1	>2.1
Others	Intra-cranial pressure (ICP) = 6-12 (cm H2O)	CSF gram stain, CSF culture, CSF bacterial antigen	PCR of HSV-DNA, VZV	CSF gram stain, CSF india ink	PCR of TB-DNA	CSF tumour markers such as alpha fetoprotein, CEA

References

↑ "National guidelines for analysis of cerebrospinal fluid for bilirubin in suspected subarachnoid haemorrhage". Ann. Clin. Biochem. 40 (Pt 5): 481–8. September 2003. doi:10.1258/000456303322326399. PMID 14503985.
↑ ^2.0 ^2.1 ^2.2 Le Rhun E, Taillibert S, Chamberlain MC (2013). "Carcinomatous meningitis: Leptomeningeal metastases in solid tumors". Surg Neurol Int. 4 (Suppl 4): S265–88. doi:10.4103/2152-7806.111304. PMC 3656567. PMID 23717798.
↑ ^3.0 ^3.1 ^3.2 Chow E, Troy SB (2014). "The differential diagnosis of hypoglycorrhachia in adult patients". Am J Med Sci. 348 (3): 186–90. doi:10.1097/MAJ.0000000000000217. PMC 4065645. PMID 24326618.
↑ ^4.0 ^4.1 ^4.2 Leen WG, Willemsen MA, Wevers RA, Verbeek MM (2012). "Cerebrospinal fluid glucose and lactate: age-specific reference values and implications for clinical practice". PLoS One. 7 (8): e42745. doi:10.1371/journal.pone.0042745. PMC 3412827. PMID 22880096.
↑ ^5.0 ^5.1 ^5.2 ^5.3 Negrini B, Kelleher KJ, Wald ER (2000). "Cerebrospinal fluid findings in aseptic versus bacterial meningitis". Pediatrics. 105 (2): 316–9. PMID 10654948.
↑ ^6.0 ^6.1 Brouwer MC, Tunkel AR, van de Beek D (2010). "Epidemiology, diagnosis, and antimicrobial treatment of acute bacterial meningitis". Clin Microbiol Rev. 23 (3): 467–92. doi:10.1128/CMR.00070-09. PMC 2901656. PMID 20610819.
↑ Vermeulen M, Hasan D, Blijenberg BG, Hijdra A, van Gijn J (July 1989). "Xanthochromia after subarachnoid haemorrhage needs no revisitation". J. Neurol. Neurosurg. Psychiatry. 52 (7): 826–8. doi:10.1136/jnnp.52.7.826. PMC 1031927. PMID 2769274.
↑ Wasay M, Mekan SF, Khelaeni B, Saeed Z, Hassan A, Cheema Z, Bakshi R (June 2005). "Extra temporal involvement in herpes simplex encephalitis". Eur. J. Neurol. 12 (6): 475–9. doi:10.1111/j.1468-1331.2005.00999.x. PMID 15885053.
↑ Glaser CA, Honarmand S, Anderson LJ, Schnurr DP, Forghani B, Cossen CK, Schuster FL, Christie LJ, Tureen JH (December 2006). "Beyond viruses: clinical profiles and etiologies associated with encephalitis". Clin. Infect. Dis. 43 (12): 1565–77. doi:10.1086/509330. PMID 17109290.
↑ Meltzer EO, Hamilos DL (May 2011). "Rhinosinusitis diagnosis and management for the clinician: a synopsis of recent consensus guidelines". Mayo Clin. Proc. 86 (5): 427–43. doi:10.4065/mcp.2010.0392. PMC 3084646. PMID 21490181.
↑ Rasmussen BK, Jensen R, Schroll M, Olesen J (1991). "Epidemiology of headache in a general population--a prevalence study". J Clin Epidemiol. 44 (11): 1147–57. doi:10.1016/0895-4356(91)90147-2. PMID 1941010.
↑ Kelman L (October 2004). "The premonitory symptoms (prodrome): a tertiary care study of 893 migraineurs". Headache. 44 (9): 865–72. doi:10.1111/j.1526-4610.2004.04168.x. PMID 15447695.
↑ Laurell K, Artto V, Bendtsen L, Hagen K, Häggström J, Linde M, Söderström L, Tronvik E, Wessman M, Zwart JA, Kallela M (September 2016). "Premonitory symptoms in migraine: A cross-sectional study in 2714 persons". Cephalalgia. 36 (10): 951–9. doi:10.1177/0333102415620251. PMID 26643378.
↑ Charlotte E. Grayson and The Cleveland Clinic Neuroscience Center (October 2004). "Cluster Headaches". WebMD. Retrieved 2006-09-22.
↑ Drummond PD (October 1994). "Sweating and vascular responses in the face: normal regulation and dysfunction in migraine, cluster headache and harlequin syndrome". Clin. Auton. Res. 4 (5): 273–85. doi:10.1007/BF01827433. PMID 7888747.
↑ Drummond PD (June 2006). "Mechanisms of autonomic disturbance in the face during and between attacks of cluster headache". Cephalalgia. 26 (6): 633–41. doi:10.1111/j.1468-2982.2006.01106.x. PMID 16686902.
↑ Ekbom K (August 1990). "Evaluation of clinical criteria for cluster headache with special reference to the classification of the International Headache Society". Cephalalgia. 10 (4): 195–7. doi:10.1046/j.1468-2982.1990.1004195.x. PMID 2245469.
↑ Sandrini G, Antonaci F, Pucci E, Bono G, Nappi G (December 1994). "Comparative study with EMG, pressure algometry and manual palpation in tension-type headache and migraine". Cephalalgia. 14 (6): 451–7, discussion 394–5. doi:10.1046/j.1468-2982.1994.1406451.x. PMID 7697707.
↑ Jensen R, Fuglsang-Frederiksen A (June 1994). "Quantitative surface EMG of pericranial muscles. Relation to age and sex in a general population". Electroencephalogr Clin Neurophysiol. 93 (3): 175–83. doi:10.1016/0168-5597(94)90038-8. PMID 7515793.
↑ Manford M (2001). "Assessment and investigation of possible epileptic seizures". J Neurol Neurosurg Psychiatry. 70 Suppl 2: II3–8. PMC 1765557. PMID 11385043.
↑ Carbonnelle E (2009). "[Laboratory diagnosis of bacterial meningitis: usefulness of various tests for the determination of the etiological agent]". Med Mal Infect. 39 (7–8): 581–605. doi:10.1016/j.medmal.2009.02.017. PMID 19398286.
↑ Morgenstern LB, Frankowski RF (1999). "Brain tumor masquerading as stroke". J Neurooncol. 44 (1): 47–52. PMID 10582668.
↑ 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.
↑ Birenbaum D, Bancroft LW, Felsberg GJ (2011). "Imaging in acute stroke". West J Emerg Med. 12 (1): 67–76. PMC 3088377. PMID 21694755.
↑ 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.
↑ 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.
↑ Berger JR, Dean D (2014). "Neurosyphilis". Handb Clin Neurol. 121: 1461–72. doi:10.1016/B978-0-7020-4088-7.00098-5. PMID 24365430.
↑ 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.
↑ Caudie C, Tholance Y, Quadrio I, Peysson S (2010). "[Contribution of CSF analysis to diagnosis and follow-up of tuberculous meningitis]". Ann Biol Clin (Paris). 68 (1): 107–11. doi:10.1684/abc.2010.0407. PMID 20146981.

Template:WikiDoc Sources

[pmid14503985-1] "National guidelines for analysis of cerebrospinal fluid for bilirubin in suspected subarachnoid haemorrhage". Ann. Clin. Biochem. 40 (Pt 5): 481–8. September 2003. doi:10.1258/000456303322326399. PMID 14503985.

[pmid23717798-2] 2.0 ^2.1 ^2.2 Le Rhun E, Taillibert S, Chamberlain MC (2013). "Carcinomatous meningitis: Leptomeningeal metastases in solid tumors". Surg Neurol Int. 4 (Suppl 4): S265–88. doi:10.4103/2152-7806.111304. PMC 3656567. PMID 23717798.

[pmid24326618-3] 3.0 ^3.1 ^3.2 Chow E, Troy SB (2014). "The differential diagnosis of hypoglycorrhachia in adult patients". Am J Med Sci. 348 (3): 186–90. doi:10.1097/MAJ.0000000000000217. PMC 4065645. PMID 24326618.

[pmid22880096-4] 4.0 ^4.1 ^4.2 Leen WG, Willemsen MA, Wevers RA, Verbeek MM (2012). "Cerebrospinal fluid glucose and lactate: age-specific reference values and implications for clinical practice". PLoS One. 7 (8): e42745. doi:10.1371/journal.pone.0042745. PMC 3412827. PMID 22880096.

[pmid10654948-5] 5.0 ^5.1 ^5.2 ^5.3 Negrini B, Kelleher KJ, Wald ER (2000). "Cerebrospinal fluid findings in aseptic versus bacterial meningitis". Pediatrics. 105 (2): 316–9. PMID 10654948.

[pmid20610819-6] 6.0 ^6.1 Brouwer MC, Tunkel AR, van de Beek D (2010). "Epidemiology, diagnosis, and antimicrobial treatment of acute bacterial meningitis". Clin Microbiol Rev. 23 (3): 467–92. doi:10.1128/CMR.00070-09. PMC 2901656. PMID 20610819.

[pmid2769274-7] Vermeulen M, Hasan D, Blijenberg BG, Hijdra A, van Gijn J (July 1989). "Xanthochromia after subarachnoid haemorrhage needs no revisitation". J. Neurol. Neurosurg. Psychiatry. 52 (7): 826–8. doi:10.1136/jnnp.52.7.826. PMC 1031927. PMID 2769274.

[pmid15885053-8] Wasay M, Mekan SF, Khelaeni B, Saeed Z, Hassan A, Cheema Z, Bakshi R (June 2005). "Extra temporal involvement in herpes simplex encephalitis". Eur. J. Neurol. 12 (6): 475–9. doi:10.1111/j.1468-1331.2005.00999.x. PMID 15885053.

[pmid17109290-9] Glaser CA, Honarmand S, Anderson LJ, Schnurr DP, Forghani B, Cossen CK, Schuster FL, Christie LJ, Tureen JH (December 2006). "Beyond viruses: clinical profiles and etiologies associated with encephalitis". Clin. Infect. Dis. 43 (12): 1565–77. doi:10.1086/509330. PMID 17109290.

[pmid21490181-10] Meltzer EO, Hamilos DL (May 2011). "Rhinosinusitis diagnosis and management for the clinician: a synopsis of recent consensus guidelines". Mayo Clin. Proc. 86 (5): 427–43. doi:10.4065/mcp.2010.0392. PMC 3084646. PMID 21490181.

[pmid1941010-11] Rasmussen BK, Jensen R, Schroll M, Olesen J (1991). "Epidemiology of headache in a general population--a prevalence study". J Clin Epidemiol. 44 (11): 1147–57. doi:10.1016/0895-4356(91)90147-2. PMID 1941010.

[pmid15447695-12] Kelman L (October 2004). "The premonitory symptoms (prodrome): a tertiary care study of 893 migraineurs". Headache. 44 (9): 865–72. doi:10.1111/j.1526-4610.2004.04168.x. PMID 15447695.

[pmid26643378-13] Laurell K, Artto V, Bendtsen L, Hagen K, Häggström J, Linde M, Söderström L, Tronvik E, Wessman M, Zwart JA, Kallela M (September 2016). "Premonitory symptoms in migraine: A cross-sectional study in 2714 persons". Cephalalgia. 36 (10): 951–9. doi:10.1177/0333102415620251. PMID 26643378.

[14] Charlotte E. Grayson and The Cleveland Clinic Neuroscience Center (October 2004). "Cluster Headaches". WebMD. Retrieved 2006-09-22.

[pmid7888747-15] Drummond PD (October 1994). "Sweating and vascular responses in the face: normal regulation and dysfunction in migraine, cluster headache and harlequin syndrome". Clin. Auton. Res. 4 (5): 273–85. doi:10.1007/BF01827433. PMID 7888747.

[pmid16686902-16] Drummond PD (June 2006). "Mechanisms of autonomic disturbance in the face during and between attacks of cluster headache". Cephalalgia. 26 (6): 633–41. doi:10.1111/j.1468-2982.2006.01106.x. PMID 16686902.

[pmid2245469-17] Ekbom K (August 1990). "Evaluation of clinical criteria for cluster headache with special reference to the classification of the International Headache Society". Cephalalgia. 10 (4): 195–7. doi:10.1046/j.1468-2982.1990.1004195.x. PMID 2245469.

[pmid7697707-18] Sandrini G, Antonaci F, Pucci E, Bono G, Nappi G (December 1994). "Comparative study with EMG, pressure algometry and manual palpation in tension-type headache and migraine". Cephalalgia. 14 (6): 451–7, discussion 394–5. doi:10.1046/j.1468-2982.1994.1406451.x. PMID 7697707.

[pmid7515793-19] Jensen R, Fuglsang-Frederiksen A (June 1994). "Quantitative surface EMG of pericranial muscles. Relation to age and sex in a general population". Electroencephalogr Clin Neurophysiol. 93 (3): 175–83. doi:10.1016/0168-5597(94)90038-8. PMID 7515793.

[pmid11385043-20] Manford M (2001). "Assessment and investigation of possible epileptic seizures". J Neurol Neurosurg Psychiatry. 70 Suppl 2: II3–8. PMC 1765557. PMID 11385043.

[pmid19398286-21] Carbonnelle E (2009). "[Laboratory diagnosis of bacterial meningitis: usefulness of various tests for the determination of the etiological agent]". Med Mal Infect. 39 (7–8): 581–605. doi:10.1016/j.medmal.2009.02.017. PMID 19398286.

[pmid10582668-22] Morgenstern LB, Frankowski RF (1999). "Brain tumor masquerading as stroke". J Neurooncol. 44 (1): 47–52. PMID 10582668.

[pmid21371327-23] 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.

[pmid21694755-24] Birenbaum D, Bancroft LW, Felsberg GJ (2011). "Imaging in acute stroke". West J Emerg Med. 12 (1): 67–76. PMC 3088377. PMID 21694755.

[pmid21807345-25] 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.

[pmid22482824-26] 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.

[pmid24365430-27] Berger JR, Dean D (2014). "Neurosyphilis". Handb Clin Neurol. 121: 1461–72. doi:10.1016/B978-0-7020-4088-7.00098-5. PMID 24365430.

[pmid22421697-28] 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.

[pmid20146981-29] Caudie C, Tholance Y, Quadrio I, Peysson S (2010). "[Contribution of CSF analysis to diagnosis and follow-up of tuberculous meningitis]". Ann Biol Clin (Paris). 68 (1): 107–11. doi:10.1684/abc.2010.0407. PMID 20146981.

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@@ Line 1: / Line 1: @@
 __NOTOC__
-{{Headache}}
+[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Headache]]
+'''For the WikiDoc page for this topic, click [[Headache|here]]'''
 {{CMG}} {{AE}} {{SAI}}
+Differential diagnosis of headache includes: Migraine, tension-type headache, cluster headache, seizure, meningitis, encephalitis, neurosyphilis, SAH, subdural hematoma, brain tumor, hypertensive encephalopathy, brain abscess, multiple sclerosis, hemorrhagic stroke, Wernickes encephalopathy, and drug toxicity etc.<ref name="pmid14503985">{{cite journal |vauthors= |title=National guidelines for analysis of cerebrospinal fluid for bilirubin in suspected subarachnoid haemorrhage |journal=Ann. Clin. Biochem. |volume=40 |issue=Pt 5 |pages=481–8 |date=September 2003 |pmid=14503985 |doi=10.1258/000456303322326399 |url=}}</ref><ref name="pmid23717798">{{cite journal| author=Le Rhun E, Taillibert S, Chamberlain MC| title=Carcinomatous meningitis: Leptomeningeal metastases in solid tumors. | journal=Surg Neurol Int | year= 2013 | volume= 4 | issue= Suppl 4 | pages= S265-88 | pmid=23717798 | doi=10.4103/2152-7806.111304 | pmc=3656567 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23717798  }} </ref><ref name="pmid24326618">{{cite journal| author=Chow E, Troy SB| title=The differential diagnosis of hypoglycorrhachia in adult patients. | journal=Am J Med Sci | year= 2014 | volume= 348 | issue= 3 | pages= 186-90 | pmid=24326618 | doi=10.1097/MAJ.0000000000000217 | pmc=4065645 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24326618  }} </ref><ref name="pmid22880096">{{cite journal| author=Leen WG, Willemsen MA, Wevers RA, Verbeek MM| title=Cerebrospinal fluid glucose and lactate: age-specific reference values and implications for clinical practice. | journal=PLoS One | year= 2012 | volume= 7 | issue= 8 | pages= e42745 | pmid=22880096 | doi=10.1371/journal.pone.0042745 | pmc=3412827 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22880096  }} </ref><ref name="pmid10654948">{{cite journal| author=Negrini B, Kelleher KJ, Wald ER| title=Cerebrospinal fluid findings in aseptic versus bacterial meningitis. | journal=Pediatrics | year= 2000 | volume= 105 | issue= 2 | pages= 316-9 | pmid=10654948 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10654948  }} </ref><ref name="pmid20610819">{{cite journal| author=Brouwer MC, Tunkel AR, van de Beek D| title=Epidemiology, diagnosis, and antimicrobial treatment of acute bacterial meningitis. | journal=Clin Microbiol Rev | year= 2010 | volume= 23 | issue= 3 | pages= 467-92 | pmid=20610819 | doi=10.1128/CMR.00070-09 | pmc=2901656 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20610819  }} </ref><ref name="pmid2769274">{{cite journal |vauthors=Vermeulen M, Hasan D, Blijenberg BG, Hijdra A, van Gijn J |title=Xanthochromia after subarachnoid haemorrhage needs no revisitation |journal=J. Neurol. Neurosurg. Psychiatry |volume=52 |issue=7 |pages=826–8 |date=July 1989 |pmid=2769274 |pmc=1031927 |doi=10.1136/jnnp.52.7.826 |url=}}</ref><ref name="pmid15885053">{{cite journal |vauthors=Wasay M, Mekan SF, Khelaeni B, Saeed Z, Hassan A, Cheema Z, Bakshi R |title=Extra temporal involvement in herpes simplex encephalitis |journal=Eur. J. Neurol. |volume=12 |issue=6 |pages=475–9 |date=June 2005 |pmid=15885053 |doi=10.1111/j.1468-1331.2005.00999.x |url=}}</ref><ref name="pmid17109290">{{cite journal |vauthors=Glaser CA, Honarmand S, Anderson LJ, Schnurr DP, Forghani B, Cossen CK, Schuster FL, Christie LJ, Tureen JH |title=Beyond viruses: clinical profiles and etiologies associated with encephalitis |journal=Clin. Infect. Dis. |volume=43 |issue=12 |pages=1565–77 |date=December 2006 |pmid=17109290 |doi=10.1086/509330 |url=}}</ref><ref name="pmid21490181">{{cite journal |vauthors=Meltzer EO, Hamilos DL |title=Rhinosinusitis diagnosis and management for the clinician: a synopsis of recent consensus guidelines |journal=Mayo Clin. Proc. |volume=86 |issue=5 |pages=427–43 |date=May 2011 |pmid=21490181 |pmc=3084646 |doi=10.4065/mcp.2010.0392 |url=}}</ref><ref name="pmid1941010">{{cite journal |vauthors=Rasmussen BK, Jensen R, Schroll M, Olesen J |title=Epidemiology of headache in a general population--a prevalence study |journal=J Clin Epidemiol |volume=44 |issue=11 |pages=1147–57 |date=1991 |pmid=1941010 |doi=10.1016/0895-4356(91)90147-2 |url=}}</ref><ref name="pmid15447695">{{cite journal |vauthors=Kelman L |title=The premonitory symptoms (prodrome): a tertiary care study of 893 migraineurs |journal=Headache |volume=44 |issue=9 |pages=865–72 |date=October 2004 |pmid=15447695 |doi=10.1111/j.1526-4610.2004.04168.x |url=}}</ref><ref name="pmid26643378">{{cite journal |vauthors=Laurell K, Artto V, Bendtsen L, Hagen K, Häggström J, Linde M, Söderström L, Tronvik E, Wessman M, Zwart JA, Kallela M |title=Premonitory symptoms in migraine: A cross-sectional study in 2714 persons |journal=Cephalalgia |volume=36 |issue=10 |pages=951–9 |date=September 2016 |pmid=26643378 |doi=10.1177/0333102415620251 |url=}}</ref><ref>{{cite web | author=Charlotte E. Grayson and The Cleveland Clinic Neuroscience Center | title=Cluster Headaches  |url=http://www.webmd.com/content/article/46/1826_50688.htm | date=October 2004 | publisher=WebMD | accessdate=2006-09-22}}</ref><ref name="pmid7888747">{{cite journal |vauthors=Drummond PD |title=Sweating and vascular responses in the face: normal regulation and dysfunction in migraine, cluster headache and harlequin syndrome |journal=Clin. Auton. Res. |volume=4 |issue=5 |pages=273–85 |date=October 1994 |pmid=7888747 |doi=10.1007/BF01827433 |url=}}</ref><ref name="pmid16686902">{{cite journal |vauthors=Drummond PD |title=Mechanisms of autonomic disturbance in the face during and between attacks of cluster headache |journal=Cephalalgia |volume=26 |issue=6 |pages=633–41 |date=June 2006 |pmid=16686902 |doi=10.1111/j.1468-2982.2006.01106.x |url=}}</ref><ref name="pmid2245469">{{cite journal |vauthors=Ekbom K |title=Evaluation of clinical criteria for cluster headache with special reference to the classification of the International Headache Society |journal=Cephalalgia |volume=10 |issue=4 |pages=195–7 |date=August 1990 |pmid=2245469 |doi=10.1046/j.1468-2982.1990.1004195.x |url=}}</ref><ref name="pmid7697707">{{cite journal |vauthors=Sandrini G, Antonaci F, Pucci E, Bono G, Nappi G |title=Comparative study with EMG, pressure algometry and manual palpation in tension-type headache and migraine |journal=Cephalalgia |volume=14 |issue=6 |pages=451–7; discussion 394–5 |date=December 1994 |pmid=7697707 |doi=10.1046/j.1468-2982.1994.1406451.x |url=}}</ref><ref name="pmid7515793">{{cite journal |vauthors=Jensen R, Fuglsang-Frederiksen A |title=Quantitative surface EMG of pericranial muscles. Relation to age and sex in a general population |journal=Electroencephalogr Clin Neurophysiol |volume=93 |issue=3 |pages=175–83 |date=June 1994 |pmid=7515793 |doi=10.1016/0168-5597(94)90038-8 |url=}}</ref>
+</small></small>
 {| class="wikitable"
 |+
 ! rowspan="2" |Disease
-! colspan="15" |History and Physical Examination
+! colspan="13" |History and Physical Examination
 ! rowspan="2" |PMHx
 ! colspan="3" |Diagnostic approach
 |-
-!Unilateral
 !Bilateral
 !Throbbing character
@@ Line 20: / Line 23: @@
 !LOC
 !Aura
-!Nause/vomiting
+!Nause/
+Vomiting
 !Rash
 !Neck stiffness
 !Vision changes
-!Facial tenderness
 !Neurologic  deficits
 !Labs and CSF findings
@@ Line 30: / Line 33: @@
 !Gold standard test
 |-
-|Migraine
+|[[Migraine]]
-|<nowiki>+</nowiki>
 |<nowiki>-</nowiki>
 | +
@@ Line 44: / Line 46: @@
 |<nowiki>-</nowiki>
 | +
-|<nowiki>-</nowiki>
 |<nowiki>-</nowiki>
 |Trigger factors, family hx
@@ Line 51: / Line 52: @@
 |Clinical assesment
 |-
-|Tension-type headache (TTH)
+|[[Tension-type headache|Tension-type headache (TTH)]]
-|<nowiki>-</nowiki>
 |<nowiki>+</nowiki>
 | -
@@ Line 66: / Line 66: @@
 | -
 |<nowiki>-</nowiki>
-|<nowiki>-</nowiki>
+|[[stress]], [[genetics]]
-|stress, genetics
 |<nowiki>-</nowiki>
 |<nowiki>-</nowiki>
 |Clinical assesment
 |-
-|Cluster headache
+|[[Cluster headache]]
-|<nowiki>+</nowiki>
 |<nowiki>-</nowiki>
 |<nowiki>-</nowiki>
@@ Line 86: / Line 84: @@
 |<nowiki>-</nowiki>
 |<nowiki>+</nowiki>
-|<nowiki>-</nowiki>
 |<nowiki>-</nowiki>
 |episodic history
@@ Line 94: / Line 91: @@
 |-
 |[[Seizure]]
-|<nowiki>-</nowiki>
 |<nowiki>+</nowiki>
 |<nowiki>-</nowiki>
@@ Line 103: / Line 99: @@
 |<nowiki>+</nowiki>
 |<nowiki>+/-</nowiki>
-|<nowiki>-</nowiki>
 |<nowiki>-</nowiki>
 |<nowiki>-</nowiki>
@@ Line 109: / Line 104: @@
 |<nowiki>-</nowiki>
 |<nowiki>+/-</nowiki>
-|Hx of seizures
+|Hx of [[Seizure|seizures]]
 |prolactin level
 |<nowiki>+/- mass lesion</nowiki>
-|EEG
+|[[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>
 |-
-|Meningitis
+|[[Meningitis]]
-|<nowiki>-</nowiki>
 |<nowiki>+</nowiki>
 |<nowiki>-</nowiki>
@@ Line 127: / Line 121: @@
 |<nowiki>+/-</nowiki>
 |<nowiki>+</nowiki>
-|<nowiki>-</nowiki>
 |<nowiki>-</nowiki>
 |<nowiki>+</nowiki>
-|Hx of fever, malaise
+|Hx of [[fever]], [[malaise]]
-|<math>\uparrow</math>WBC
+|[[Leukocytosis|<math>\uparrow</math>WBC]]
 <math>\uparrow</math>Protein
@@ Line 137: / Line 130: @@
 <math>\downarrow</math>glucose
 |<nowiki>+/-</nowiki>
-|CSF analysis
+|[[CSF analysis]]<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>
 |-
-|Encephalitis
+|[[Encephalitis]]
-|<nowiki>-</nowiki>
 |<nowiki>+</nowiki>
 |<nowiki>+/-</nowiki>
@@ Line 152: / Line 144: @@
 |<nowiki>+/-</nowiki>
 |<nowiki>+</nowiki>
-|<nowiki>-</nowiki>
 |<nowiki>-</nowiki>
 |<nowiki>+</nowiki>
-|Hx of fever, malaise
+|Hx of [[fever]], [[malaise]]
 |elevated WBC, low glucose
 |<nowiki>+</nowiki>
 |CSF PCR
 |-
-|[[Brain tumor]]
+|[[Brain tumor]]<ref name="pmid10582668">{{cite journal| author=Morgenstern LB, Frankowski RF| title=Brain tumor masquerading as stroke. | journal=J Neurooncol | year= 1999 | volume= 44 | issue= 1 | pages= 47-52 | pmid=10582668 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10582668  }}</ref>
-|<nowiki>-</nowiki>
 |<nowiki>+</nowiki>
 |<nowiki>-</nowiki>
@@ Line 174: / Line 164: @@
 |<nowiki>-</nowiki>
 |<nowiki>+/-</nowiki>
-|<nowiki>-</nowiki>
 |<nowiki>+/-</nowiki>
-|weight loss, fatigue
+|[[weight loss]], [[fatigue]]
-|neuromarkers
+|neuromarkers,
+Cancer cells<ref name="pmid21371327">{{cite journal| author=Weston CL, Glantz MJ, Connor JR| title=Detection of cancer cells in the cerebrospinal fluid: current methods and future directions. | journal=Fluids Barriers CNS | year= 2011 | volume= 8 | issue= 1 | pages= 14 | pmid=21371327 | doi=10.1186/2045-8118-8-14 | pmc=3059292 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21371327  }}</ref>
 |<nowiki>+/- mass</nowiki>
-|MRI
+|[[MRI]]
 |-
 |[[Subdural hematoma|Subdural hemorrhage]]
-|<nowiki>-/+</nowiki>
 |<nowiki>-/+</nowiki>
 |<nowiki>+/-</nowiki>
@@ Line 195: / Line 184: @@
 |<nowiki>-</nowiki>
 |<nowiki>+/-</nowiki>
-|<nowiki>-</nowiki>
 |<nowiki>+/-</nowiki>
-|Trauma, fall
+|[[Trauma]], [[fall]]
 |Xanthochromia
 |<nowiki>+</nowiki>
 |CT w/o contrast
 |-
-|Subarachnoid hemorrhage
+|[[Subarachnoid hemorrhage]]
-|<nowiki>-/+</nowiki>
+| -/+
-|<nowiki>+</nowiki>
 |<nowiki>+/-</nowiki>
 |<nowiki>-</nowiki>
@@ Line 216: / Line 203: @@
 |<nowiki>+/-</nowiki>
 |<nowiki>+/-</nowiki>
-|<nowiki>-</nowiki>
 |<nowiki>+/-</nowiki>
-|thunderclap headache
+|[[thunderclap headache]]
 |<math>\uparrow</math>opening pressure, xanthochromia
 |<nowiki>+</nowiki>
 |CT w/o contrast
 |-
-|Hypertensive encephalopathy
+|[[Hypertensive encephalopathy]]
-|<nowiki>-</nowiki>
 |<nowiki>+</nowiki>
 |<nowiki>+/-</nowiki>
@@ Line 238: / Line 223: @@
 |<nowiki>+/-</nowiki>
 |<nowiki>-</nowiki>
-|<nowiki>-</nowiki>
+|[[Hypertension]]
-|Hypertension
 |UA +/-
 |<nowiki>+/-</nowiki>
@@ Line 245: / Line 229: @@
 |-
 |[[Brain abscess|CNS abscess]]
-|<nowiki>-/+</nowiki>
 |<nowiki>-/+</nowiki>
 |<nowiki>-</nowiki>
@@ Line 258: / Line 241: @@
 |<nowiki>+/-</nowiki>
 |<nowiki>+/-</nowiki>
-|<nowiki>-</nowiki>
 |<nowiki>+/-</nowiki>
 |History of [[drug abuse]], [[endocarditis]], [[immunosupression]]
-|'''↑''' leukocytes, '''↓''' glucose and '''↑''' protien
+|'''↑''' [[Leukocytosis|leukocytes]], '''↓''' [[glucose]] and '''↑''' protien
 |<nowiki>+</nowiki>
-|MRI
+|[[MRI]]
 |-
 |[[Conversion disorder]]
-|<nowiki>-/+</nowiki>
 |<nowiki>-/+</nowiki>
 |<nowiki>-</nowiki>
@@ Line 279: / Line 260: @@
 |<nowiki>+/-</nowiki>
 |<nowiki>+/-</nowiki>
-|<nowiki>-</nowiki>
 |<nowiki>+/-</nowiki>
 |History of [[emotional stress]]
@@ Line 287: / Line 267: @@
 |-
 |[[Multiple sclerosis]]
-|<nowiki>-/+</nowiki>
 |<nowiki>-/+</nowiki>
 |<nowiki>-</nowiki>
@@ Line 300: / Line 279: @@
 |<nowiki>-</nowiki>
 |<nowiki>+</nowiki>
-|<nowiki>-</nowiki>
 |<nowiki>+/-</nowiki>
 |History of relapses and remissions
-|'''↑'''  CSF IgG levels
+|'''↑'''  [[CSF]] [[IgG]] levels
 (monoclonal bands)
 |<nowiki>+</nowiki>
-|MRI
+|[[MRI]]
 |-
 |[[Hemorrhagic stroke]]
-|<nowiki>-/+</nowiki>
 |<nowiki>-/+</nowiki>
 |<nowiki>+/-</nowiki>
@@ Line 323: / Line 300: @@
 |<nowiki>-</nowiki>
 |<nowiki>+/-</nowiki>
-|<nowiki>-</nowiki>
 |<nowiki>+/-</nowiki>
-|HTN
+|[[Hypertension|HTN]]
 |<nowiki>-</nowiki>
 |<nowiki>+</nowiki>
-|CT scan  without contrast<ref name="pmid21694755">{{cite journal| author=Birenbaum D, Bancroft LW, Felsberg GJ| title=Imaging in acute stroke. | journal=West J Emerg Med | year= 2011 | volume= 12 | issue= 1 | pages= 67-76 | pmid=21694755 | doi= | pmc=3088377 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21694755  }}</ref><ref name="pmid21807345">{{cite journal| author=DeLaPaz RL, Wippold FJ, Cornelius RS, Amin-Hanjani S, Angtuaco EJ, Broderick DF et al.| title=ACR Appropriateness Criteria® on cerebrovascular disease. | journal=J Am Coll Radiol | year= 2011 | volume= 8 | issue= 8 | pages= 532-8 | pmid=21807345 | doi=10.1016/j.jacr.2011.05.010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21807345  }}</ref>
+|[[CT scan]]  without contrast<ref name="pmid21694755">{{cite journal| author=Birenbaum D, Bancroft LW, Felsberg GJ| title=Imaging in acute stroke. | journal=West J Emerg Med | year= 2011 | volume= 12 | issue= 1 | pages= 67-76 | pmid=21694755 | doi= | pmc=3088377 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21694755  }}</ref><ref name="pmid21807345">{{cite journal| author=DeLaPaz RL, Wippold FJ, Cornelius RS, Amin-Hanjani S, Angtuaco EJ, Broderick DF et al.| title=ACR Appropriateness Criteria® on cerebrovascular disease. | journal=J Am Coll Radiol | year= 2011 | volume= 8 | issue= 8 | pages= 532-8 | pmid=21807345 | doi=10.1016/j.jacr.2011.05.010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21807345  }}</ref>
 |-
-|[[Neurosyphilis]]
+|[[Neurosyphilis]]<ref name="pmid22482824">{{cite journal| author=Liu LL, Zheng WH, Tong ML, Liu GL, Zhang HL, Fu ZG et al.| title=Ischemic stroke as a primary symptom of neurosyphilis among HIV-negative emergency patients. | journal=J Neurol Sci | year= 2012 | volume= 317 | issue= 1-2 | pages= 35-9 | pmid=22482824 | doi=10.1016/j.jns.2012.03.003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22482824  }}</ref><ref name="pmid24365430">{{cite journal |vauthors=Berger JR, Dean D |title=Neurosyphilis |journal=Handb Clin Neurol |volume=121 |issue= |pages=1461–72 |year=2014 |pmid=24365430 |doi=10.1016/B978-0-7020-4088-7.00098-5 |url=}}</ref>
-|<nowiki>-/+</nowiki>
 |<nowiki>-/+</nowiki>
 |<nowiki>-</nowiki>
@@ Line 344: / Line 319: @@
 |<nowiki>-</nowiki>
 |<nowiki>+/-</nowiki>
-|<nowiki>-</nowiki>
 |<nowiki>+/-</nowiki>
 |[[Sexually transmitted disease|STI]]<nowiki/>s
@@ Line 354: / Line 328: @@
 |-
 |[[Wernicke's encephalopathy|Wernicke’s encephalopathy]]
-|<nowiki>-</nowiki>
 |<nowiki>-/+</nowiki>
 |<nowiki>-</nowiki>
@@ Line 367: / Line 340: @@
 |<nowiki>-</nowiki>
 |<nowiki>+/-</nowiki>
-|<nowiki>-</nowiki>
 |<nowiki>+/-</nowiki>
 |History of alcohal abuse
@@ Line 375: / Line 347: @@
 |-
 |[[Drug toxicity]]
-|<nowiki>-</nowiki>
 |<nowiki>-/+</nowiki>
 |<nowiki>-</nowiki>
@@ Line 388: / Line 359: @@
 |<nowiki>+/-</nowiki>
 |<nowiki>+/-</nowiki>
-|<nowiki>-</nowiki>
 |<nowiki>+/-</nowiki>
 |Medication hx
@@ Line 395: / Line 365: @@
 |Drug screen test
 |-
-|Metabolic disturbances
+|[[Metabolic disorder|Metabolic disturbances]]
-|<nowiki>-</nowiki>
 |<nowiki>-/+</nowiki>
 |<nowiki>-</nowiki>
@@ Line 409: / Line 378: @@
 |<nowiki>-</nowiki>
 |<nowiki>+/-</nowiki>
-|<nowiki>-</nowiki>
 |<nowiki>+/-</nowiki>
-|Underlying CKD, CLD
+|Underlying [[CKD]], CLD
 |[[Hypoglycemia]], [[Hyponatremia|hypo]] and [[hypernatremia]], [[Hypokalemia|hypo]] and [[hyperkalemia]]
 |<nowiki>-</nowiki>
 |Cause dependent
 |-
-|NPH
+|[[Sinusitis]]
-|<nowiki>-</nowiki>
 |<nowiki>-/+</nowiki>
-|<nowiki>-</nowiki>
-|<nowiki>-</nowiki>
-|<nowiki>-</nowiki>
-|<nowiki>-</nowiki>
-|<nowiki>-</nowiki>
-|<nowiki>-</nowiki>
-|<nowiki>-</nowiki>
-|<nowiki>-</nowiki>
 |<nowiki>-</nowiki>
 |<nowiki>-</nowiki>
@@ Line 432: / Line 391: @@
 |<nowiki>-</nowiki>
 |<nowiki>-</nowiki>
-|OCP use, meds
 |<nowiki>-</nowiki>
-|<nowiki>+/-</nowiki>
-|CT  and clinical
-|-
-|Sinusitis
 |<nowiki>-</nowiki>
-|<nowiki>-/+</nowiki>
 |<nowiki>-</nowiki>
 |<nowiki>-</nowiki>
-|<nowiki>+/-</nowiki>
 |<nowiki>-</nowiki>
 |<nowiki>-</nowiki>
 |<nowiki>-</nowiki>
-|<nowiki>-</nowiki>
+|[[allergies]], seasonal
-|<nowiki>-</nowiki>
+|[[leukocytosis]]
-|<nowiki>-</nowiki>
-|<nowiki>-</nowiki>
-|<nowiki>-</nowiki>
-|<nowiki>-</nowiki>
-|<nowiki>-</nowiki>
-|allergies, seasonal
-|leukocytosis
 |<nowiki>+</nowiki>
-|CT
+|[[CT-scans|CT]]
 |}
 </small></small>
+==Diagnsotic Labs For Meningitis==
+Diagnosis of meningitis, is based on clinical presentation in combination with CSF analysis. CSF analysis has major role for diagnosis and rule out other possibilities. The following table summarizes the CSF findings in different types of meningitis.<ref name="pmid23717798">{{cite journal| author=Le Rhun E, Taillibert S, Chamberlain MC| title=Carcinomatous meningitis: Leptomeningeal metastases in solid tumors. | journal=Surg Neurol Int | year= 2013 | volume= 4 | issue= Suppl 4 | pages= S265-88 | pmid=23717798 | doi=10.4103/2152-7806.111304 | pmc=3656567 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23717798  }} </ref><ref name="pmid24326618">{{cite journal| author=Chow E, Troy SB| title=The differential diagnosis of hypoglycorrhachia in adult patients. | journal=Am J Med Sci | year= 2014 | volume= 348 | issue= 3 | pages= 186-90 | pmid=24326618 | doi=10.1097/MAJ.0000000000000217 | pmc=4065645 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24326618  }} </ref><ref name="pmid22880096">{{cite journal| author=Leen WG, Willemsen MA, Wevers RA, Verbeek MM| title=Cerebrospinal fluid glucose and lactate: age-specific reference values and implications for clinical practice. | journal=PLoS One | year= 2012 | volume= 7 | issue= 8 | pages= e42745 | pmid=22880096 | doi=10.1371/journal.pone.0042745 | pmc=3412827 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22880096  }} </ref><ref name="pmid10654948">{{cite journal| author=Negrini B, Kelleher KJ, Wald ER| title=Cerebrospinal fluid findings in aseptic versus bacterial meningitis. | journal=Pediatrics | year= 2000 | volume= 105 | issue= 2 | pages= 316-9 | pmid=10654948 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10654948  }} </ref><ref name="pmid20610819">{{cite journal| author=Brouwer MC, Tunkel AR, van de Beek D| title=Epidemiology, diagnosis, and antimicrobial treatment of acute bacterial meningitis. | journal=Clin Microbiol Rev | year= 2010 | volume= 23 | issue= 3 | pages= 467-92 | pmid=20610819 | doi=10.1128/CMR.00070-09 | pmc=2901656 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20610819  }} </ref>
+{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
+|+
+! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF|Cerebrospinal fluid level}}
+! style="background: #4479BA; width: 350px;" | {{fontcolor|#FFF|Normal level}}
+! style="background: #4479BA; width: 350px;" | {{fontcolor|#FFF|Bacterial meningitis}}<ref name="pmid10654948">{{cite journal| author=Negrini B, Kelleher KJ, Wald ER| title=Cerebrospinal fluid findings in aseptic versus bacterial meningitis. | journal=Pediatrics | year= 2000 | volume= 105 | issue= 2 | pages= 316-9 | pmid=10654948 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10654948  }} </ref>
+! style="background: #4479BA; width: 350px;" | {{fontcolor|#FFF|Viral meningitis}}<ref name="pmid10654948">{{cite journal| author=Negrini B, Kelleher KJ, Wald ER| title=Cerebrospinal fluid findings in aseptic versus bacterial meningitis. | journal=Pediatrics | year= 2000 | volume= 105 | issue= 2 | pages= 316-9 | pmid=10654948 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10654948  }} </ref>
+! style="background: #4479BA; width: 350px;" | {{fontcolor|#FFF|Fungal meningitis}}
+! style="background: #4479BA; width: 350px;" | {{fontcolor|#FFF|Tuberculous meningitis}}<ref name="pmid20146981">{{cite journal| author=Caudie C, Tholance Y, Quadrio I, Peysson S| title=[Contribution of CSF analysis to diagnosis and follow-up of tuberculous meningitis]. | journal=Ann Biol Clin (Paris) | year= 2010 | volume= 68 | issue= 1 | pages= 107-11 | pmid=20146981 | doi=10.1684/abc.2010.0407 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20146981  }} </ref>
+! style="background: #4479BA; width: 350px;" | {{fontcolor|#FFF|Neoplastic meningitis}}<ref name="pmid23717798">{{cite journal| author=Le Rhun E, Taillibert S, Chamberlain MC| title=Carcinomatous meningitis: Leptomeningeal metastases in solid tumors. | journal=Surg Neurol Int | year= 2013 | volume= 4 | issue= Suppl 4 | pages= S265-88 | pmid=23717798 | doi=10.4103/2152-7806.111304 | pmc=3656567 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23717798  }} </ref>
+|-
+| style="padding: 5px 5px; background: #DCDCDC;" | '''Cells/ul'''
+| style="padding: 5px 5px; background: #F5F5F5;" |'''< 5'''
+| style="padding: 5px 5px; background: #F5F5F5;" |'''>300'''
+| style="padding: 5px 5px; background: #F5F5F5;" |'''10-1000'''
+| style="padding: 5px 5px; background: #F5F5F5;" |'''10-500'''
+| style="padding: 5px 5px; background: #F5F5F5;" |'''50-500'''
+| style="padding: 5px 5px; background: #F5F5F5;" |'''>4'''
+|-
+| style="padding: 5px 5px; background: #DCDCDC;" |'''Cells'''
+| style="padding: 5px 5px; background: #F5F5F5;" |'''[[Lymphocyte]]'''
+| style="padding: 5px 5px; background: #F5F5F5;" |'''[[Leukocyte]] > [[Lymphocyte]]'''
+| style="padding: 5px 5px; background: #F5F5F5;" |'''[[Lymphocyte]] > [[Leukocyte]]'''
+| style="padding: 5px 5px; background: #F5F5F5;" |'''[[Lymphocyte]] > [[Leukocyte]]'''
+| style="padding: 5px 5px; background: #F5F5F5;" |'''[[Lymphocyte]] > [[Leukocyte]]'''
+| style="padding: 5px 5px; background: #F5F5F5;" |'''[[Lymphocyte]] > [[Leukocyte]]'''
+|-
+| style="padding: 5px 5px; background: #DCDCDC;" |'''Total protein (mg/dl''')
+| style="padding: 5px 5px; background: #F5F5F5;" |'''45-60'''
+| style="padding: 5px 5px; background: #F5F5F5;" |'''Typically 100-500'''
+| style="padding: 5px 5px; background: #F5F5F5;" | '''Normal or slightly high'''
+| style="padding: 5px 5px; background: #F5F5F5;" |'''High'''
+| style="padding: 5px 5px; background: #F5F5F5;" |'''Typically 100-200'''
+| style="padding: 5px 5px; background: #F5F5F5;" |'''>50'''
+|-
+| style="padding: 5px 5px; background: #DCDCDC;" |'''Glucose ratio (CSF/plasma)<ref name="pmid24326618">{{cite journal| author=Chow E, Troy SB| title=The differential diagnosis of hypoglycorrhachia in adult patients. | journal=Am J Med Sci | year= 2014 | volume= 348 | issue= 3 | pages= 186-90 | pmid=24326618 | doi=10.1097/MAJ.0000000000000217 | pmc=4065645 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24326618  }} </ref>'''
+| style="padding: 5px 5px; background: #F5F5F5;" |'''> 0.5'''
+| style="padding: 5px 5px; background: #F5F5F5;" |'''< 0.3'''
+| style="padding: 5px 5px; background: #F5F5F5;" |'''> 0.6'''
+| style="padding: 5px 5px; background: #F5F5F5;" |'''<0.3'''
+| style="padding: 5px 5px; background: #F5F5F5;" |'''< 0.5'''
+| style="padding: 5px 5px; background: #F5F5F5;" |'''<0.5'''
+|-
+| style="padding: 5px 5px; background: #DCDCDC;" |'''Lactate (mmols/l)<ref name="pmid22880096">{{cite journal| author=Leen WG, Willemsen MA, Wevers RA, Verbeek MM| title=Cerebrospinal fluid glucose and lactate: age-specific reference values and implications for clinical practice. | journal=PLoS One | year= 2012 | volume= 7 | issue= 8 | pages= e42745 | pmid=22880096 | doi=10.1371/journal.pone.0042745 | pmc=3412827 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22880096  }} </ref>'''
+| style="padding: 5px 5px; background: #F5F5F5;" |'''< 2.1'''
+| style="padding: 5px 5px; background: #F5F5F5;" |'''> 2.1'''
+| style="padding: 5px 5px; background: #F5F5F5;" |'''< 2.1'''
+| style="padding: 5px 5px; background: #F5F5F5;" |'''>3.2'''
+| style="padding: 5px 5px; background: #F5F5F5;" |'''> 2.1'''
+| style="padding: 5px 5px; background: #F5F5F5;" |'''>2.1'''
+|-
+| style="padding: 5px 5px; background: #DCDCDC;" |'''Others'''
+| style="padding: 5px 5px; background: #F5F5F5;" |'''[[Intracranial pressure|Intra-cranial pressure]] (ICP) = 6-12 (cm H2O)'''
+| style="padding: 5px 5px; background: #F5F5F5;" |'''CSF [[gram stain]], CSF culture, CSF bacterial antigen'''
+| style="padding: 5px 5px; background: #F5F5F5;" |'''[[PCR]] of HSV-DNA, VZV'''
+| style="padding: 5px 5px; background: #F5F5F5;" |'''CSF [[gram stain]], CSF india ink'''
+| style="padding: 5px 5px; background: #F5F5F5;" |'''[[PCR]] of TB-DNA'''
+| style="padding: 5px 5px; background: #F5F5F5;" |'''CSF tumour markers such as [[Alpha-fetoprotein|alpha fetoprotein]], [[CEA]]'''
+|-
+|}
 ==References==
 {{reflist|2}}
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+{{WikiDoc Sources}}
 [[Category:Headaches]]
@@ Line 467: / Line 477: @@
 [[Category:Neurology]]
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Headache differential diagnosis: Difference between revisions

Latest revision as of 21:58, 29 July 2020

Diagnsotic Labs For Meningitis

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