Bacterial meningitis differential diagnosis: Difference between revisions

Latest revision as of 20:34, 29 July 2020

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

Overview

The differential diagnosis of bacterial meningitis includes two step approach. First is differentiating bacterial meningitis from other diseases which have similar clinical presentation as bacterial meningitis such as encephalitis, brain abscess, subarachnoid hemorrage, and brain tumour. Second step involves CSF examination and differentiating bacterial meningitis from viral, fungal and other causes of meningitis.^[1]^[2]^[3]^[4]^[5]^[6]^[7]^[8]^[9]^[10]^[11]^[12]^[13]^[14]^[15]^[16]

Differential diagnosis

Bacterial meningitis may mimick other diseases in terms of clinical signs and symptoms. It is important to differentiate meningitis from other diseases with similar presentation. Once the diagnsis of meningitis is confirmed, the next step may be to differentiate different types of meningitis on the basis of CSF examnination:^[1]^[2]^[3]^[4]^[5]^[6]^[7]^[8]^[9]^[10]^[11]^[12]^[13]^[14]^[15]^[16]

Differentiating bacterial meningitis from other diseases

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
Brain tumour^[2]^[3]		✔	Cancer cells^[4]	MRI		✔	✔	✔	✔	✔		✔		Cachexia, gradual progression of symptoms
Delerium Tremens		✔		Clinical diagnosis		✔	✔		✔	✔	✔	✔	Alcohal intake, sudden witdrawl or reduction in consumption	Tachycardia, diaphoresis, hypertension, tremors, mydriasis, positional nystagmus, tachypnea
Subarachnoid hemorrhage^[17]		✔	Xanthochromia^[5]	CT scan without contrast^[7]^[8]	✔	✔	✔	✔	✔	✔	✔	✔	Trauma/fall	Confusion, dizziness, nausea, vomiting
Stroke		✔	Normal	CT scan without contrast		✔	✔		✔	✔		✔	TIAs, hypertension, diabetes mellitus	Speech difficulty, gait abnormality
Neurosyphilis^[18]^[19]		✔	↑ Leukocytes and protein	CSF VDRL-specifc CSF FTA-Ab -sensitive^[20]	✔	✔	✔	✔		✔		✔	Unprotected sexual intercourse, STIs	Blindness, confusion, depression, Abnormal gait
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
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, ↓ immune status	High grade fever, fatigue,nausea, vomiting
Drug toxicity											✔	✔		Lithium, Sedatives, phenytoin, carbamazepine
Conversion disorder				Diagnosis of exclusion		✔		✔		✔	✔	✔		Tremors, blindness, difficulty swallowing
Electrolyte disturbance	↓ or ↑			Depends on the cause						✔		✔		Confusion, seizures
Febrile seizures			Not performed in first simple febrile seizures	Clinical diagnosis and EEG					✔	✔	✔	✔	Family history of febrile seizures, viral illness or gastroenteritis	Age > 1 month,
Subdural empyema		✔		Clinical assesment and MRI	✔	✔	✔	✔	✔			✔	History of relapses and remissions	Blurry vision, urinary incontinence, fatigue
Hypoglycemia	↓ or ↑			Serum blood glucose HbA1c		✔				✔		✔	History of diabetes	Palpitations, sweating, dizziness, low serum, glucose

Differentiating bacterial meningitis from other causes of meningitis

Bacterial meningitis may be differntiated from other causes of meningitis by cerebrospinal fluid examination:^[21]^[22]^[23]^[24]^[25]


Cerebrospinal fluid level	Normal level	Bacterial meningitis^[24]	Viral meningitis^[24]	Fungal meningitis	Tuberculous meningitis^[26]	Malignant meningitis^[21]
Cells/ul	< 5	>300	10-1000	10-500	50-500	>4
Cells	Lymphos:Monos 7:3	Gran. > Lymph	Lymph. > Gran.	Lympho.>Gran	Lymphocytes	Lymphocytes
Total protein (mg/dl)	45-60	Typically 100-500	Normal or slightly high	High	Typically 100-200	>50
Glucose ratio (CSF/plasma)^[22]	> 0.5	< 0.3	> 0.6	<0.3	< 0.5	<0.5
Lactate (mmols/l)^[23]	< 2.1	> 2.1	< 2.1	>3.2	> 2.1	>2.1
Others	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 TBC-DNA	CSF tumour markers such as alpha fetoproteins, CEA

References

↑ ^1.0 ^1.1 Stern TA, Celano CM, Gross AF, Huffman JC, Freudenreich O, Kontos N; et al. (2010). "The assessment and management of agitation and delirium in the general hospital". Prim Care Companion J Clin Psychiatry. 12 (1): PCC.09r00938. doi:10.4088/PCC.09r00938yel. PMC 2882819. PMID 20582303.
↑ ^2.0 ^2.1 ^2.2 Soffer D (1976) Brain tumors simulating purulent meningitis. Eur Neurol 14 (3):192-7. PMID: 1278192
↑ ^3.0 ^3.1 ^3.2 Terheggen HG (1985) [CNS tumors with the clinical picture of meningitis.] Monatsschr Kinderheilkd 133 (1):13-9. PMID: 3883130
↑ ^4.0 ^4.1 ^4.2 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.
↑ ^5.0 ^5.1 ^5.2 Lee MC, Heaney LM, Jacobson RL, Klassen AC (1975). "Cerebrospinal fluid in cerebral hemorrhage and infarction". Stroke. 6 (6): 638–41. PMID 1198628.
↑ ^6.0 ^6.1 Han JH, Wilber ST (2013). "Altered mental status in older patients in the emergency department". Clin Geriatr Med. 29 (1): 101–36. doi:10.1016/j.cger.2012.09.005. PMC 3614410. PMID 23177603.
↑ ^7.0 ^7.1 ^7.2 Birenbaum D, Bancroft LW, Felsberg GJ (2011). "Imaging in acute stroke". West J Emerg Med. 12 (1): 67–76. PMC 3088377. PMID 21694755.
↑ ^8.0 ^8.1 ^8.2 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.
↑ ^9.0 ^9.1 Stein MT, Trauner D (1982). "The child with a stiff neck". Clin Pediatr (Phila). 21 (9): 559–63. PMID 7105615.
↑ ^10.0 ^10.1 De Cauwer HG, Eykens L, Hellinckx J, Mortelmans LJ (2007). "Differential diagnosis between viral and bacterial meningitis in children". Eur J Emerg Med. 14 (6): 343–7. doi:10.1097/MEJ.0b013e328270366b. PMID 17968200.
↑ ^11.0 ^11.1 Spanos A, Harrell FE, Durack DT (1989). "Differential diagnosis of acute meningitis. An analysis of the predictive value of initial observations". JAMA. 262 (19): 2700–7. PMID 2810603.
↑ ^12.0 ^12.1 Lindquist L, Linné T, Hansson LO, Kalin M, Axelsson G (1988). "Value of cerebrospinal fluid analysis in the differential diagnosis of meningitis: a study in 710 patients with suspected central nervous system infection". Eur J Clin Microbiol Infect Dis. 7 (3): 374–80. PMID 3137038.
↑ ^13.0 ^13.1 Naganuma M, Fujioka S, Inatomi Y, Yonehara T, Hashimoto Y, Hirano T; et al. (2008). "Clinical characteristics of subarachnoid hemorrhage with or without headache". J Stroke Cerebrovasc Dis. 17 (6): 334–9. doi:10.1016/j.jstrokecerebrovasdis.2008.04.009. PMID 18984423.
↑ ^14.0 ^14.1 Rajnik M, Ottolini MG (2000). "Serious infections of the central nervous system: encephalitis, meningitis, and brain abscess". Adolesc Med. 11 (2): 401–25. PMID 10916131.
↑ ^15.0 ^15.1 Tyler KL (2004). "Herpes simplex virus infections of the central nervous system: encephalitis and meningitis, including Mollaret's". Herpes. 11 Suppl 2: 57A–64A. PMID 15319091.
↑ ^16.0 ^16.1 Kennedy PG (2004). "Viral encephalitis: causes, differential diagnosis, and management". J Neurol Neurosurg Psychiatry. 75 Suppl 1: i10–5. PMC 1765650. PMID 14978145.
↑ 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
↑ 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.
↑ ^21.0 ^21.1 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.
↑ ^22.0 ^22.1 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.
↑ ^23.0 ^23.1 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.
↑ ^24.0 ^24.1 ^24.2 Negrini B, Kelleher KJ, Wald ER (2000). "Cerebrospinal fluid findings in aseptic versus bacterial meningitis". Pediatrics. 105 (2): 316–9. PMID 10654948.
↑ 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.
↑ 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

[pmid20582303-1] 1.0 ^1.1 Stern TA, Celano CM, Gross AF, Huffman JC, Freudenreich O, Kontos N; et al. (2010). "The assessment and management of agitation and delirium in the general hospital". Prim Care Companion J Clin Psychiatry. 12 (1): PCC.09r00938. doi:10.4088/PCC.09r00938yel. PMC 2882819. PMID 20582303.

[pmid1278192-2] 2.0 ^2.1 ^2.2 Soffer D (1976) Brain tumors simulating purulent meningitis. Eur Neurol 14 (3):192-7. PMID: 1278192

[pmid3883130-3] 3.0 ^3.1 ^3.2 Terheggen HG (1985) [CNS tumors with the clinical picture of meningitis.] Monatsschr Kinderheilkd 133 (1):13-9. PMID: 3883130

[pmid21371327-4] 4.0 ^4.1 ^4.2 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.

[pmid1198628-5] 5.0 ^5.1 ^5.2 Lee MC, Heaney LM, Jacobson RL, Klassen AC (1975). "Cerebrospinal fluid in cerebral hemorrhage and infarction". Stroke. 6 (6): 638–41. PMID 1198628.

[pmid23177603-6] 6.0 ^6.1 Han JH, Wilber ST (2013). "Altered mental status in older patients in the emergency department". Clin Geriatr Med. 29 (1): 101–36. doi:10.1016/j.cger.2012.09.005. PMC 3614410. PMID 23177603.

[pmid21694755-7] 7.0 ^7.1 ^7.2 Birenbaum D, Bancroft LW, Felsberg GJ (2011). "Imaging in acute stroke". West J Emerg Med. 12 (1): 67–76. PMC 3088377. PMID 21694755.

[pmid21807345-8] 8.0 ^8.1 ^8.2 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.

[pmid7105615-9] 9.0 ^9.1 Stein MT, Trauner D (1982). "The child with a stiff neck". Clin Pediatr (Phila). 21 (9): 559–63. PMID 7105615.

[pmid17968200-10] 10.0 ^10.1 De Cauwer HG, Eykens L, Hellinckx J, Mortelmans LJ (2007). "Differential diagnosis between viral and bacterial meningitis in children". Eur J Emerg Med. 14 (6): 343–7. doi:10.1097/MEJ.0b013e328270366b. PMID 17968200.

[pmid2810603-11] 11.0 ^11.1 Spanos A, Harrell FE, Durack DT (1989). "Differential diagnosis of acute meningitis. An analysis of the predictive value of initial observations". JAMA. 262 (19): 2700–7. PMID 2810603.

[pmid3137038-12] 12.0 ^12.1 Lindquist L, Linné T, Hansson LO, Kalin M, Axelsson G (1988). "Value of cerebrospinal fluid analysis in the differential diagnosis of meningitis: a study in 710 patients with suspected central nervous system infection". Eur J Clin Microbiol Infect Dis. 7 (3): 374–80. PMID 3137038.

[pmid18984423-13] 13.0 ^13.1 Naganuma M, Fujioka S, Inatomi Y, Yonehara T, Hashimoto Y, Hirano T; et al. (2008). "Clinical characteristics of subarachnoid hemorrhage with or without headache". J Stroke Cerebrovasc Dis. 17 (6): 334–9. doi:10.1016/j.jstrokecerebrovasdis.2008.04.009. PMID 18984423.

[pmid10916131-14] 14.0 ^14.1 Rajnik M, Ottolini MG (2000). "Serious infections of the central nervous system: encephalitis, meningitis, and brain abscess". Adolesc Med. 11 (2): 401–25. PMID 10916131.

[pmid15319091-15] 15.0 ^15.1 Tyler KL (2004). "Herpes simplex virus infections of the central nervous system: encephalitis and meningitis, including Mollaret's". Herpes. 11 Suppl 2: 57A–64A. PMID 15319091.

[pmid14978145-16] 16.0 ^16.1 Kennedy PG (2004). "Viral encephalitis: causes, differential diagnosis, and management". J Neurol Neurosurg Psychiatry. 75 Suppl 1: i10–5. PMC 1765650. PMID 14978145.

[pmid14585453-17] 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

[pmid22482824-18] 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.

[pmid24365430-19] Berger JR, Dean D (2014). "Neurosyphilis". Handb Clin Neurol. 121: 1461–72. doi:10.1016/B978-0-7020-4088-7.00098-5. PMID 24365430.

[pmid22421697-20] 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.

[pmid23717798-21] 21.0 ^21.1 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.

[pmid24326618-22] 22.0 ^22.1 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.

[pmid22880096-23] 23.0 ^23.1 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.

[pmid10654948-24] 24.0 ^24.1 ^24.2 Negrini B, Kelleher KJ, Wald ER (2000). "Cerebrospinal fluid findings in aseptic versus bacterial meningitis". Pediatrics. 105 (2): 316–9. PMID 10654948.

[pmid20610819-25] 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.

[pmid20146981-26] 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__
-{{Bacterial meningitis}}
+[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Bacterial_meningitis]]
 {{CMG}}; {{AE}} {{AA}}
@@ Line 10: / Line 10: @@
 ===Differentiating bacterial meningitis from other diseases===
 {|
-|-style="background: #4479BA; color: #FFFFFF; text-align: center;"
+|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
 ! rowspan="2" |<small>Diseases</small>
 ! colspan="4" |<small>Diagnostic tests</small>
 ! colspan="5" |<small>Physical Examination</small>
 ! colspan="3" |<small>Symptoms
-! colspan="1" |<small>Past medical history</small>
+! colspan="1" rowspan="2" |<small>Past medical history</small>
 ! rowspan="2" |<small>Other Findings</small>
-|-style="background: #4479BA; color: #FFFFFF; text-align: center;"
+|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
 !<small>Na+, K+, Ca2+</small>
 !<small>CT /MRI</small>
@@ Line 30: / Line 30: @@
 !<small>Fever</small>
 !<small>Altered mental status</small>
-!
 |-
-|style="background: #DCDCDC; padding: 5px; text-align: center;" | Brain tumour<ref name="pmid1278192">Soffer D (1976) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=1278192 Brain tumors simulating purulent meningitis.] ''Eur Neurol'' 14 (3):192-7. PMID: [http://pubmed.gov/1278192 1278192]</ref><ref name="pmid3883130" />
+| style="background: #DCDCDC; padding: 5px; text-align: center;" | [[Brain tumor|Brain tumour]]<ref name="pmid1278192">Soffer D (1976) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=1278192 Brain tumors simulating purulent meningitis.] ''Eur Neurol'' 14 (3):192-7. PMID: [http://pubmed.gov/1278192 1278192]</ref><ref name="pmid3883130" />
-|style="background: #F5F5F5; padding: 5px;" |
+| style="background: #F5F5F5; padding: 5px;" |
-|style="background: #F5F5F5; padding: 5px; text-align:center"|✔
+| style="background: #F5F5F5; padding: 5px; text-align:center" |✔
-|style="background: #F5F5F5; padding: 5px text-align:center" |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>
+| style="background: #F5F5F5; padding: 5px text-align:center" |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>
-|style="background: #F5F5F5; padding: 5px;" |MRI
+| style="background: #F5F5F5; padding: 5px;" |MRI
 | 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" |✔
+| style="background: #F5F5F5; padding: 5px; text-align:center" |✔
-|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;" |[[Cachexia]], gradual progression of symptoms
+| style="background: #F5F5F5; padding: 5px;" |[[Cachexia]], gradual progression of symptoms
 |-
-|style="background: #DCDCDC; padding: 5px; text-align: center;" |Delerium Tremens
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Delirium tremens|Delerium Tremens]]
-|style="background: #F5F5F5; padding: 5px;" |
+| style="background: #F5F5F5; padding: 5px;" |
-|style="background: #F5F5F5; padding: 5px; text-align:center" |✔
+| style="background: #F5F5F5; padding: 5px; text-align:center" |✔
 | style="background: #F5F5F5; padding: 5px;" |
 | style="background: #F5F5F5; padding: 5px;" |Clinical diagnosis
 | style="background: #F5F5F5; padding: 5px; text-align:center" |
-|style="background: #F5F5F5; padding: 5px; text-align:center" |✔
+| style="background: #F5F5F5; padding: 5px; text-align:center" |✔
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+| 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;" |Alcohal intake, sudden witdrawl or reduction in consumption
+| style="background: #F5F5F5; padding: 5px;" |Alcohal intake, sudden witdrawl or reduction in consumption
-|style="background: #F5F5F5; padding: 5px;" |Tachycardia, diaphoresis, hypertension, tremors, mydriasis, positional nystagmus, tachypnea
+| style="background: #F5F5F5; padding: 5px;" |Tachycardia, diaphoresis, hypertension, tremors, mydriasis, positional nystagmus, tachypnea
 |-
-|style="background: #DCDCDC; padding: 5px; text-align: center;" | 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>
+| style="background: #DCDCDC; padding: 5px; text-align: center;" | [[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>
-|style="background: #F5F5F5; padding: 5px;" |
+| style="background: #F5F5F5; padding: 5px;" |
-|style="background: #F5F5F5; padding: 5px; text-align:center" |✔
+| style="background: #F5F5F5; padding: 5px; text-align:center" |✔
-|style="background: #F5F5F5; padding: 5px;" |Xanthochromia<ref name="pmid1198628">{{cite journal| author=Lee MC, Heaney LM, Jacobson RL, Klassen AC| title=Cerebrospinal fluid in cerebral hemorrhage and infarction. | journal=Stroke | year= 1975 | volume= 6 | issue= 6 | pages= 638-41 | pmid=1198628 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1198628  }}</ref>
+| style="background: #F5F5F5; padding: 5px;" |Xanthochromia<ref name="pmid1198628">{{cite journal| author=Lee MC, Heaney LM, Jacobson RL, Klassen AC| title=Cerebrospinal fluid in cerebral hemorrhage and infarction. | journal=Stroke | year= 1975 | volume= 6 | issue= 6 | pages= 638-41 | pmid=1198628 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1198628  }}</ref>
-|style="background: #F5F5F5; padding: 5px;" |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>
+| style="background: #F5F5F5; padding: 5px;" |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>
-|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" |     ✔
-|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;" |Trauma/fall
+| style="background: #F5F5F5; padding: 5px;" |Trauma/fall
-|style="background: #F5F5F5; padding: 5px;" |Confusion, dizziness, nausea, vomiting
+| style="background: #F5F5F5; padding: 5px;" |Confusion, dizziness, nausea, vomiting
 |-
-|style="background: #DCDCDC; padding: 5px; text-align: center;" | Stroke
+| style="background: #DCDCDC; padding: 5px; text-align: center;" | [[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"| Normal
+| style="background: #F5F5F5; padding: 5px; text-align:center" | Normal
-|style="background: #F5F5F5; padding: 5px; text-align:center"| CT scan  without contrast
+| style="background: #F5F5F5; padding: 5px; text-align:center" | CT scan  without contrast
-|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"|✔
+| 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"|TIAs, hypertension, diabetes mellitus
+| 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;" |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>
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[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>
-|style="background: #F5F5F5; padding: 5px;" |
+| style="background: #F5F5F5; padding: 5px;" |
-|style="background: #F5F5F5; padding: 5px; text-align:center" |✔
+| style="background: #F5F5F5; padding: 5px; text-align:center" |✔
-|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>
-|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;" |
+| style="background: #F5F5F5; padding: 5px;" |
-|style="background: #F5F5F5; padding: 5px; text-align:center" |✔
+| style="background: #F5F5F5; padding: 5px; text-align:center" |✔
-|style="background: #F5F5F5; padding: 5px;" |
+| style="background: #F5F5F5; padding: 5px;" |
-|style="background: #F5F5F5; padding: 5px; text-align:center" |✔
+| style="background: #F5F5F5; padding: 5px; text-align:center" |✔
-|style="background: #F5F5F5; padding: 5px;" |Unprotected sexual intercourse, STIs
+| style="background: #F5F5F5; padding: 5px;" |Unprotected sexual intercourse, STIs
-|style="background: #F5F5F5; padding: 5px;" |Blindness, confusion, [[depression]],
+| style="background: #F5F5F5; padding: 5px;" |Blindness, confusion, [[depression]],
 Abnormal [[gait]]
 |-
-|style="background: #DCDCDC; padding: 5px; text-align: center;" |Viral encephalitis
+| 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;" |✔
+| style="background: #F5F5F5; padding: 5px;" |✔
-|style="background: #F5F5F5; padding: 5px;" |Increased RBCS or xanthochromia, mononuclear lymphocytosis, high protein content, normal glucose
+| style="background: #F5F5F5; padding: 5px;" |Increased RBCS or xanthochromia, mononuclear lymphocytosis, high protein content, normal glucose
-|style="background: #F5F5F5; padding: 5px;" |Clinical assesment
+| style="background: #F5F5F5; padding: 5px;" |Clinical assesment
-|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;text-align:center" |✔
+| style="background: #F5F5F5; padding: 5px;text-align:center" |✔
-|style="background: #F5F5F5; padding: 5px;" |
+| style="background: #F5F5F5; padding: 5px;" |
 | style="background: #F5F5F5; padding: 5px;" |    ✔
-|style="background: #F5F5F5; padding: 5px; text-align:center" |✔
+| style="background: #F5F5F5; padding: 5px; text-align:center" |✔
-|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;" |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
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Herpes simplex encephalitis]]
-|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;" |Clinical assesment
+| style="background: #F5F5F5; padding: 5px;" |Clinical assesment
-|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;" |✔
-|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 hypertension
+| 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;" |Wernicke’s encephalopathy
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Wernicke's Encephalopathy|Wernicke’s encephalopathy]]
-|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;" |Normal
+| style="background: #F5F5F5; padding: 5px;" |Normal
-|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;" |✔
-|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 alcohal abuse
+| 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: #DCDCDC; padding: 5px; text-align: center;" |[[CNS abscess]]
-|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;" |'''↑''' leukocytes >100,000/ul, '''↓''' glucose and '''↑''' protien, '''↑''' red blood cells, lactic acid >500mg
+| style="background: #F5F5F5; padding: 5px;" |'''↑''' leukocytes >100,000/ul, '''↓''' glucose and '''↑''' protien, '''↑''' red blood cells, lactic acid >500mg
-|style="background: #F5F5F5; padding: 5px;" |Contrast enhanced MRI is more sensitive and specific,
+| 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;" |✔
-|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;" |✔
-|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 drug abuse, endocarditis, '''↓''' immune status
+| style="background: #F5F5F5; padding: 5px;" |History of drug abuse, endocarditis, '''↓''' immune status
-|style="background: #F5F5F5; padding: 5px;" |High grade fever, fatigue,nausea, vomiting
+| style="background: #F5F5F5; padding: 5px;" |High grade fever, fatigue,nausea, vomiting
 |-
-|style="background: #DCDCDC; padding: 5px; text-align: center;" |Drug toxicity
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Drug toxicity]]
-|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;" |
-|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;" |✔
-|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;" |Lithium, Sedatives, phenytoin, carbamazepine
+| style="background: #F5F5F5; padding: 5px;" |Lithium, Sedatives, phenytoin, carbamazepine
 |-
-|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;" |
+| style="background: #F5F5F5; padding: 5px;" |
 | style="background: #F5F5F5; padding: 5px;" |
-|style="background: #F5F5F5; padding: 5px;" |
+| style="background: #F5F5F5; padding: 5px;" |Diagnosis of exclusion
-|style="background: #F5F5F5; padding: 5px;" |
-|style="background: #F5F5F5; padding: 5px;" |Diagnosis of exclusion
 | 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;" |
+| style="background: #F5F5F5; padding: 5px;" |
 | 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;" |
+| 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;" |Electrolyte disturbance
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Electrolyte disturbance]]
-|style="background: #F5F5F5; padding: 5px; text-align:center" |'''↓''' or '''↑'''
+| style="background: #F5F5F5; padding: 5px; text-align:center" |'''↓''' 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;" |Depends on the cause
+| style="background: #F5F5F5; padding: 5px;" |Depends on the cause
-|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;" |
-|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;" |Confusion, seizures
+| style="background: #F5F5F5; padding: 5px;" |Confusion, seizures
 |-
-| style="background: #DCDCDC; padding: 5px; text-align: center;" |Febrile seizures
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Febrile seizure|Febrile seizures]]
 | style="background: #F5F5F5; padding: 5px;" |
 | style="background: #F5F5F5; padding: 5px;" |
@@ Line 245: / Line 244: @@
 | style="background: #F5F5F5; padding: 5px;" |Age > 1 month,
 |-
-| style="background: #DCDCDC; padding: 5px; text-align: center;" |Subdural empyema
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Subdural empyema]]
 | style="background: #F5F5F5; padding: 5px;" |
 | style="background: #F5F5F5; padding: 5px; text-align:center" |✔
@@ Line 261: / Line 260: @@
 | style="background: #F5F5F5; padding: 5px;" |Blurry vision, [[urinary incontinence]], [[fatigue]]
 |-
-| style="background: #DCDCDC; padding: 5px; text-align: center;" |Hypoglycemia
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Hypoglycemia]]
 | style="background: #F5F5F5; padding: 5px; text-align:center" |↓ or '''↑'''
 | style="background: #F5F5F5; padding: 5px;" |
@@ Line 280: / Line 279: @@
 ===Differentiating bacterial meningitis from other causes of meningitis===
-{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
+Bacterial meningitis may be differntiated from other causes of meningitis by cerebrospinal fluid examination:<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}}
+! 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}}
+! 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}}
+! 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|Malignant meningitis}}
+! style="background: #4479BA; width: 350px;" | {{fontcolor|#FFF|Malignant 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'''
@@ Line 314: / Line 314: @@
 | style="padding: 5px 5px; background: #F5F5F5;" |'''>50'''
 |-
-| style="padding: 5px 5px; background: #DCDCDC;" |'''Glucose ratio (CSF/plasma)'''
+| 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'''
@@ Line 322: / Line 322: @@
 | style="padding: 5px 5px; background: #F5F5F5;" |'''<0.5'''
 |-
-| style="padding: 5px 5px; background: #DCDCDC;" |'''Lactate (mmols/l)'''
+| 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'''
@@ Line 338: / Line 338: @@
 | style="padding: 5px 5px; background: #F5F5F5;" |'''CSF tumour markers such as alpha fetoproteins, CEA'''
 |-
-|}
-{|
-|-style="background:silver; color:black"
-| '''Cerebrospinal Fluid''' ||  ||  ||  ||  ||
-|-style="background:silver; color:black"
-|  || '''Normal Levels''' || '''Acute Bacterial M.''' || '''Acute Viral M.''' || '''TB M.''' || '''Neuroborreliosis'''
-|- style="background:silver; color:black"
-| '''Cells/ul''' || '''< 5''' || '''In the 1000s''' || '''In the 100s''' || '''In the 100s''' || '''Some 100'''
-|-style="background:silver; color:black"
-| '''Cells''' || '''Lymph:Monos 7:3''' || '''Gran. > Lymph.''' || '''Lymph. > Gran.''' || '''Various leukos''' || '''Lymph. monocytic'''
-|-style="background:silver; color:black"
-| '''Total Protein (mg/dl)'''  || '''45-60''' || '''Typically 100-500''' || '''Typically normal''' || '''Typically 100-200''' || '''Typically up to 350'''
-|-style="background:silver; color:black"
-| '''Glucose Ratio (CSF/plasma)'''  || '''Typically > 0.5''' || '''< 0.3''' || '''> 0.6''' || '''< 0.5''' || '''Normal'''
-|-style="background:silver; color:black"
-| '''Lactate (mmol/l)'''  || '''< 2.1''' || '''> 2.1''' || '''< 2.1''' || '''> 2.1''' || '''-'''
-|-style="background:silver; color:black"
-| '''Others''' || '''ICP: 6-22 (cm H2O)'''  ||  || '''PCR of HSV-DNA''' || '''PCR of TBC-DNA''' || '''IgG/IgM <br> CSF/Serum Ratio'''
-|}
-{| style="background:#FDF5E6;padding:0.3em; margin-left:5px; border:1px solid #996666"
-|+ style="color:#996666"|'''CSF finding in different conditions'''<ref>{{cite book |last=Provan |first= Drew|authorlink= |coauthors=Andrew Krentz |title= Oxford Handbook of clinical and laboratory investigation|year=2005 |publisher=Oxford university press |location=Oxford |isbn=0198566638 }}</ref>
-!bgcolor="#FFEFD5"|Condition !! bgcolor="#FFEFD5"|Glucose !! bgcolor="#FFEFD5"|Protein!!bgcolor="#FFEFD5"|Cells
-|-
-! bgcolor="#FFEFD5"|Acute bacterial meningitis
-| Low|| high||high, often > 300/mm³
-|-
-! bgcolor="#FFEFD5"|Acute viral meningitis
-|Normal ||normal or high|| [[Lymphocyte|mononuclear]], < 300/mm³
-|-
-! bgcolor="#FFEFD5"|Tuberculous meningitis
-|Low ||high||[[pleocytosis]], mixed < 300/mm³
-|-
-! bgcolor="#FFEFD5"|Fungal meningitis
-|Low||high||< 300/mm³
-|-
-! bgcolor="#FFEFD5"|Malignant meningitis
-|Low ||high||usually mononuclear
-|-
-! bgcolor="#FFEFD5"|Subarachnoid haemorrhage
-|Normal ||normal, or high ||[[Erythrocytes]]
 |}
@@ Line 386: / Line 345: @@
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+[[Category:Disease]]
+[[Category:Up-To-Date]]
+[[Category:Neurology]]
+[[Category:Emergency medicine]]
+[[Category:Infectious disease]]