Headache differential diagnosis: Difference between revisions
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|prolactin level | |prolactin level | ||
|<nowiki>+/- mass lesion</nowiki> | |<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> | ||
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|Meningitis | |Meningitis | ||
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<math>\downarrow</math>glucose | <math>\downarrow</math>glucose | ||
|<nowiki>+/-</nowiki> | |<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 | ||
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|CSF PCR | |CSF PCR | ||
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|[[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> | |<nowiki>+</nowiki> | ||
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|<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> | |<nowiki>+/- mass</nowiki> | ||
|MRI | |MRI | ||
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|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> | |<nowiki>-/+</nowiki> | ||
Revision as of 06:15, 11 June 2020
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Headache differential diagnosis On the Web |
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Risk calculators and risk factors for Headache differential diagnosis |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sabeeh Islam, MBBS[2]
| Disease | History and Physical Examination | PMHx | Diagnostic approach | ||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Unilateral | Bilateral | Throbbing character | Autonomic symptoms | Fever | Photophobia | Aphasia | LOC | Aura | Nause/vomiting | Rash | Neck stiffness | Vision changes | Facial tenderness | Neurologic deficits | 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 [1] |
| Meningitis | - | + | - | - | + | +/- | +/- | - | - | +/- | +/- | + | - | - | + | Hx of fever, malaise | <math>\uparrow</math>WBC
<math>\uparrow</math>Protein <math>\downarrow</math>glucose |
+/- | CSF analysis[2] |
| Encephalitis | - | + | +/- | - | + | +/- | +/- | - | - | - | +/- | + | - | - | + | Hx of fever, malaise | elevated WBC, low glucose | + | CSF PCR |
| Brain tumor[3] | - | + | - | - | - | - | +/- | - | - | +/- | - | - | +/- | - | +/- | weight loss, fatigue | neuromarkers,
Cancer cells[4] |
+/- 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[5][6] |
| Neurosyphilis[7][8] | -/+ | -/+ | - | - | - | - | - | +/- | - | - | +/- | - | +/- | - | +/- | STIs | ↑ Leukocytes and protein | + | CSF VDRL-specifc
CSF FTA-Ab -sensitive[9] |
| 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 |
| NPH | - | -/+ | - | - | - | - | - | - | - | - | - | - | +/- | - | - | OCP use, meds | - | +/- | CT and clinical |
| Sinusitis | - | -/+ | - | - | +/- | - | - | - | - | - | - | - | - | - | - | allergies, seasonal | leukocytosis | + | CT |
References
- ↑ 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.