Seizure differential diagnosis: Difference between revisions

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VisualWikitext

Latest revision as of 17:36, 26 December 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Differential diagnosis of epileptic seizures may include: concussion, drug intoxication or withdrawal, migraine, psychogenic nonepileptic events, panic attacks, sleep disorders, syncope, transient global amnesia, and transient ischemic attack (TIA).

Differentiating Seizure from other Conditions

Differential diagnosis of epileptic seizures may include:^[1]

A quick algorithm to differentiate seizure from other causes of altered mental status is demonstrated below:

Clinical presentation

Loss of conscoiusness

No

Yes

• Transient?
• Rapid onset?
• Short duration?
• Spontaneous recovery?

Falls

Altered consciousnes

Yes

No

Coma

Aborted SCD

Others

T-LOC

Non-Traumatic

Traumatic

Syncope

Epileptic seizure

Psychogenic

Rare causes

• Reflex syncope
• Orthostatic hypotension
• Cardiac syncope

• Tonic
• Clonic
• Tonic-clonic
• Atonic

• Pseudo-epileptic
• Pseudo-syncopal

Abbreviations: SCD: Sudden cardiac death;T-LOC: Transient-Loss of consciousness.

The above algorithm adopted from ESC guideline ^[2]

It can be difficult to distinguish a seizure from other conditions causing a collapse, abnormal movements or other seizure manifestations. A 2007 evidence-based review from the American Academy of Neurology and the American Epilepsy Society recommends an electroencephalogram (EEG, brain wave activity) and brain imaging with CT scan or MRI scan in the work-up of adults presenting with a first apparently unprovoked seizure. Blood tests, lumbar puncture or toxicology screening can be helpful in specific circumstances suggestive of an underlying cause like meningitis or drug overdose, but there is insufficient evidence to support their routine use in the work-up of an adult with an apparently unprovoked first seizure.^[3]

Differentiating a seizure from other conditions such as syncope can be difficult. In addition, 5% of patients with a positive tilt table test may have seizure-like activity that seems to be due to cerebral hypoxia.^[4]

As seizures have a differential diagnosis, it is common for patients to be simultaneously investigated for cardiac and endocrine causes. Checking glucose levels, for example, is a mandatory action in the management of seizures as hypoglycemia may cause seizures, and failure to administer glucose would be harmful to the patient. Other causes typically considered are syncope and cardiac arrhythmias, and occasionally, panic attacks and cataplexy. For more information, see non-epileptic seizures.

Neurosyphilis can present with seizures and must be differentiated from other causes of seizures.^[5]

Diseases	Symptoms				Physical Examination					Past medical history	Diagnostic tests			Other Findings
Diseases	Headache	↓LOC	Motor weakness	Abnormal sensory	Motor Deficit	Sensory deficit	Speech difficulty	Gait abnormality	Cranial nerves	Past medical history	CT /MRI	CSF Findings	Gold standard test	Other Findings
Meningitis	+	-	-	-	-	+	+	-	-	History of fever and malaise	-	↑ Leukocytes, ↑ Protein ↓ Glucose	CSF analysis^[6]	Fever, neck rigidity
Encephalitis	+	+	+/-	+/-	-	-	+	+/-	+	History of fever and malaise	+	↑ Leukocytes, ↓ Glucose	CSF PCR	Fever, seizures, focal neurologic abnormalities
Brain tumor^[7]	+	-	-	-	+	+	+	-	+	Weight loss, fatigue	+	Cancer cells^[8]	MRI	Cachexia, gradual progression of symptoms
Hemorrhagic stroke	+	+	+	+	+	+	+	+	-	Hypertension	+	-	CT scan without contrast^[9]^[10]	Neck stiffness
Subdural hemorrhage	+	+	+	+	+	-	-	-	+	Trauma, fall	+	Xanthochromia^[11]	CT scan without contrast^[9]^[10]	Confusion, dizziness, nausea, vomiting
Neurosyphilis^[12]^[5]	+	-	+	+	+	+	-	+	-	STIs	+	↑ Leukocytes and protein	CSF VDRL-specifc CSF FTA-Ab -sensitive^[13]	Blindness, confusion, depression, Abnormal gait
Complex or atypical migraine	+	-	+	+	-	-	+	-	-	Family history of migraine	-	-	Clinical assesment	Presence of aura, nausea, vomiting
Hypertensive encephalopathy	+	+	-	-	-	-	+	+	-	Hypertension	+	-	Clinical assesment	Delirium, cortical blindness, cerebral edema, seizure
Wernicke’s encephalopathy	-	+	-	-	-	+	+	+	+	History of alcohal abuse	-	-	Clinical assesment and lab findings	Ophthalmoplegia, confusion
CNS abscess	+	+	-	-	+	+	+	-	-	History of drug abuse, endocarditis, immunosupression	+	↑ leukocytes, ↓ glucose and ↑ protien	MRI is more sensitive and specific	High grade fever, fatigue,nausea, vomiting
Drug toxicity	-	+	-	+	+	+	-	+	-	-	-	-	Drug screen test	Lithium, Sedatives, phenytoin, carbamazepine
Conversion disorder	+	+	+	+	+	+	+	+		History of emotional stress	-	-	Diagnosis of exclusion	Tremors, blindness, difficulty swallowing
Metabolic disturbances (electrolyte imbalance, hypoglycemia)	-	+	+	+	+	+	-	-	+	-	-	Hypoglycemia, hypo and hypernatremia, hypo and hyperkalemia	Depends on the cause	Confusion, seizure, palpitations, sweating, dizziness, hypoglycemia
Multiple sclerosis exacerbation	-	-	+	+	-	+	+	+	+	History of relapses and remissions	+	↑ CSF IgG levels (monoclonal bands)	Clinical assesment and MRI ^[14]	Blurry vision, urinary incontinence, fatigue
Seizure	+	+	-	-	+	+	-	-	+	Previous history of seizures	-	Mass lesion	Clinical assesment and EEG ^[15]	Confusion, apathy, irritability,

References

↑ Johnson EL (2019). "Seizures and Epilepsy". Med Clin North Am. 103 (2): 309–324. doi:10.1016/j.mcna.2018.10.002. PMID 30704683.
↑ Moya, A.; Sutton, R.; Ammirati, F.; Blanc, J.-J.; Brignole, M.; Dahm, J. B.; Deharo, J.-C.; Gajek, J.; Gjesdal, K.; Krahn, A.; Massin, M.; Pepi, M.; Pezawas, T.; Granell, R. R.; Sarasin, F.; Ungar, A.; van Dijk, J. G.; Walma, E. P.; Wieling, W.; Abe, H.; Benditt, D. G.; Decker, W. W.; Grubb, B. P.; Kaufmann, H.; Morillo, C.; Olshansky, B.; Parry, S. W.; Sheldon, R.; Shen, W. K.; Vahanian, A.; Auricchio, A.; Bax, J.; Ceconi, C.; Dean, V.; Filippatos, G.; Funck-Brentano, C.; Hobbs, R.; Kearney, P.; McDonagh, T.; McGregor, K.; Popescu, B. A.; Reiner, Z.; Sechtem, U.; Sirnes, P. A.; Tendera, M.; Vardas, P.; Widimsky, P.; Auricchio, A.; Acarturk, E.; Andreotti, F.; Asteggiano, R.; Bauersfeld, U.; Bellou, A.; Benetos, A.; Brandt, J.; Chung, M. K.; Cortelli, P.; Da Costa, A.; Extramiana, F.; Ferro, J.; Gorenek, B.; Hedman, A.; Hirsch, R.; Kaliska, G.; Kenny, R. A.; Kjeldsen, K. P.; Lampert, R.; Molgard, H.; Paju, R.; Puodziukynas, A.; Raviele, A.; Roman, P.; Scherer, M.; Schondorf, R.; Sicari, R.; Vanbrabant, P.; Wolpert, C.; Zamorano, J. L. (2009). "Guidelines for the diagnosis and management of syncope (version 2009): The Task Force for the Diagnosis and Management of Syncope of the European Society of Cardiology (ESC)". European Heart Journal. 30 (21): 2631–2671. doi:10.1093/eurheartj/ehp298. ISSN 0195-668X.
↑ Krumholz A, Wiebe S, Gronseth G, Shinnar S, Levisohn P, Ting T, Hopp J, Shafer P, Morris H, Seiden L, Barkley G, French J; Quality Standards Subcommittee of the American Academy of Neurology; American Epilepsy Society. Practice Parameter: evaluating an apparent unprovoked first seizure in adults (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology 2007; 69(21): 1996-2007. PMID 18025394
↑ Passman R, Horvath G, Thomas J; et al. (2003). "Clinical spectrum and prevalence of neurologic events provoked by tilt table testing". Arch. Intern. Med. 163 (16): 1945–8. doi:10.1001/archinte.163.16.1945. PMID 12963568.
↑ ^5.0 ^5.1 Berger JR, Dean D (2014). "Neurosyphilis". Handb Clin Neurol. 121: 1461–72. doi:10.1016/B978-0-7020-4088-7.00098-5. PMID 24365430.
↑ 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.
↑ ^9.0 ^9.1 Birenbaum D, Bancroft LW, Felsberg GJ (2011). "Imaging in acute stroke". West J Emerg Med. 12 (1): 67–76. PMC 3088377. PMID 21694755.
↑ ^10.0 ^10.1 DeLaPaz RL, Wippold FJ, Cornelius RS, Amin-Hanjani S, Angtuaco EJ, Broderick DF; et al. (2011). "ACR Appropriateness Criteria® on cerebrovascular disease". J Am Coll Radiol. 8 (8): 532–8. doi:10.1016/j.jacr.2011.05.010. PMID 21807345.
↑ Lee MC, Heaney LM, Jacobson RL, Klassen AC (1975). "Cerebrospinal fluid in cerebral hemorrhage and infarction". Stroke. 6 (6): 638–41. PMID 1198628.
↑ 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.
↑ 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.
↑ Giang DW, Grow VM, Mooney C, Mushlin AI, Goodman AD, Mattson DH; et al. (1994). "Clinical diagnosis of multiple sclerosis. The impact of magnetic resonance imaging and ancillary testing. Rochester-Toronto Magnetic Resonance Study Group". Arch Neurol. 51 (1): 61–6. PMID 8274111.
↑ Manford M (2001). "Assessment and investigation of possible epileptic seizures". J Neurol Neurosurg Psychiatry. 70 Suppl 2: II3–8. PMC 1765557. PMID 11385043.

[pmid30704683-1] Johnson EL (2019). "Seizures and Epilepsy". Med Clin North Am. 103 (2): 309–324. doi:10.1016/j.mcna.2018.10.002. PMID 30704683.

[MoyaSutton2009-2] Moya, A.; Sutton, R.; Ammirati, F.; Blanc, J.-J.; Brignole, M.; Dahm, J. B.; Deharo, J.-C.; Gajek, J.; Gjesdal, K.; Krahn, A.; Massin, M.; Pepi, M.; Pezawas, T.; Granell, R. R.; Sarasin, F.; Ungar, A.; van Dijk, J. G.; Walma, E. P.; Wieling, W.; Abe, H.; Benditt, D. G.; Decker, W. W.; Grubb, B. P.; Kaufmann, H.; Morillo, C.; Olshansky, B.; Parry, S. W.; Sheldon, R.; Shen, W. K.; Vahanian, A.; Auricchio, A.; Bax, J.; Ceconi, C.; Dean, V.; Filippatos, G.; Funck-Brentano, C.; Hobbs, R.; Kearney, P.; McDonagh, T.; McGregor, K.; Popescu, B. A.; Reiner, Z.; Sechtem, U.; Sirnes, P. A.; Tendera, M.; Vardas, P.; Widimsky, P.; Auricchio, A.; Acarturk, E.; Andreotti, F.; Asteggiano, R.; Bauersfeld, U.; Bellou, A.; Benetos, A.; Brandt, J.; Chung, M. K.; Cortelli, P.; Da Costa, A.; Extramiana, F.; Ferro, J.; Gorenek, B.; Hedman, A.; Hirsch, R.; Kaliska, G.; Kenny, R. A.; Kjeldsen, K. P.; Lampert, R.; Molgard, H.; Paju, R.; Puodziukynas, A.; Raviele, A.; Roman, P.; Scherer, M.; Schondorf, R.; Sicari, R.; Vanbrabant, P.; Wolpert, C.; Zamorano, J. L. (2009). "Guidelines for the diagnosis and management of syncope (version 2009): The Task Force for the Diagnosis and Management of Syncope of the European Society of Cardiology (ESC)". European Heart Journal. 30 (21): 2631–2671. doi:10.1093/eurheartj/ehp298. ISSN 0195-668X.

[AAS2007-3] Krumholz A, Wiebe S, Gronseth G, Shinnar S, Levisohn P, Ting T, Hopp J, Shafer P, Morris H, Seiden L, Barkley G, French J; Quality Standards Subcommittee of the American Academy of Neurology; American Epilepsy Society. Practice Parameter: evaluating an apparent unprovoked first seizure in adults (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology 2007; 69(21): 1996-2007. PMID 18025394

[pmid12963568-4] Passman R, Horvath G, Thomas J; et al. (2003). "Clinical spectrum and prevalence of neurologic events provoked by tilt table testing". Arch. Intern. Med. 163 (16): 1945–8. doi:10.1001/archinte.163.16.1945. PMID 12963568.

[pmid24365430-5] 5.0 ^5.1 Berger JR, Dean D (2014). "Neurosyphilis". Handb Clin Neurol. 121: 1461–72. doi:10.1016/B978-0-7020-4088-7.00098-5. PMID 24365430.

[pmid19398286-6] 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.

[pmid10582668-7] Morgenstern LB, Frankowski RF (1999). "Brain tumor masquerading as stroke". J Neurooncol. 44 (1): 47–52. PMID 10582668.

[pmid21371327-8] 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.

[pmid21694755-9] 9.0 ^9.1 Birenbaum D, Bancroft LW, Felsberg GJ (2011). "Imaging in acute stroke". West J Emerg Med. 12 (1): 67–76. PMC 3088377. PMID 21694755.

[pmid21807345-10] 10.0 ^10.1 DeLaPaz RL, Wippold FJ, Cornelius RS, Amin-Hanjani S, Angtuaco EJ, Broderick DF; et al. (2011). "ACR Appropriateness Criteria® on cerebrovascular disease". J Am Coll Radiol. 8 (8): 532–8. doi:10.1016/j.jacr.2011.05.010. PMID 21807345.

[pmid1198628-11] Lee MC, Heaney LM, Jacobson RL, Klassen AC (1975). "Cerebrospinal fluid in cerebral hemorrhage and infarction". Stroke. 6 (6): 638–41. PMID 1198628.

[pmid22482824-12] 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.

[pmid22421697-13] 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.

[pmid8274111-14] Giang DW, Grow VM, Mooney C, Mushlin AI, Goodman AD, Mattson DH; et al. (1994). "Clinical diagnosis of multiple sclerosis. The impact of magnetic resonance imaging and ancillary testing. Rochester-Toronto Magnetic Resonance Study Group". Arch Neurol. 51 (1): 61–6. PMID 8274111.

[pmid11385043-15] Manford M (2001). "Assessment and investigation of possible epileptic seizures". J Neurol Neurosurg Psychiatry. 70 Suppl 2: II3–8. PMC 1765557. PMID 11385043.

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@@ Line 1: / Line 1: @@
 __NOTOC__
 {{Seizure}}
-{{CMG]]
+{{CMG}}
 ==Overview==
+[[Differential diagnosis]] of epileptic seizures may include: [[concussion]], drug [[intoxication]] or [[withdrawal]], [[migraine]], [[psychogenic]] nonepileptic events, [[panic attacks]], [[sleep disorders]], [[syncope]], [[transient global amnesia]], and [[transient ischemic attack|transient ischemic attack (TIA)]].
 ==Differentiating Seizure from other Conditions==
+[[Differential diagnosis]] of epileptic seizures may include:<ref name="pmid30704683">{{cite journal| author=Johnson EL| title=Seizures and Epilepsy. | journal=Med Clin North Am | year= 2019 | volume= 103 | issue= 2 | pages= 309-324 | pmid=30704683 | doi=10.1016/j.mcna.2018.10.002 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30704683  }} </ref>
+* [[Concussion]]
+* Drug [[intoxication]] or [[withdrawal]]
+* [[Migraine]]
+* [[Psychogenic]] nonepileptic events
+* [[Panic attacks]]
+* [[Sleep disorders]]
+* [[Syncope]]
+* [[Transient global amnesia]]
+* [[Transient ischemic attack|Transient ischemic attack (TIA)]]
+A quick algorithm to differentiate seizure from other [[causes]] of altered mental status is demonstrated below:{{familytree/start}}
+{{familytree/start}}
+{{familytree | | | | | | | | | | A01 | | | | | |A01='''Clinical presentation'''}}
+{{familytree | | | | | | | | | | |!| | | | | | | | }}
+{{familytree | | | | | | | | | | B01 | | | | | |B01=Loss of conscoiusness}}
+{{familytree | | | |,|-|-|-|-|-|-|^|-|-|-|-|-|-|.|}}
+{{familytree | | | C01 | | | | | | | | | | | | C02 |C01=No|C02=Yes}}
+{{familytree | | | |!| | | | | | | | | | | | | |!| | | | | | | | | | | }}
+{{familytree | | | |!| | | | | | | | | | | | | D02 |D02=• Transient?<br>• Rapid onset?<br>• Short duration?<br>• Spontaneous recovery?}}
+{{familytree | |,|-|^|-|.| | | | | |,|-|-|-|-|-|^|-|-|-|-|-|.|}}
+{{familytree | F04 | | F05 | | | | G04 | | | | | | | | | | G05 |F04=Falls|F05=Altered consciousnes|G04=Yes|G05=No}}
+{{familytree | | | | | | | | | | | |!| | | | | | | |,|-|-|-|+|-|-|-|.|}}
+{{familytree | | | | | | | | | | | |!| | | | | | | E02 | | E03 | | E04 |E02=[[Coma]]|E03=Aborted SCD|E04=Others}}
+{{familytree | | | | | | | | | | | D01 | | | | | | | | | | | | | |D01=T-LOC}}
+{{familytree | | | | | | | | | |,|-|^|-|.| | | | | | | | | | | | |}}
+{{familytree | | | | | | | | | D02 | | D03 | | | | | | | | | | | |D02=Non-Traumatic|D03=Traumatic}}
+{{familytree | |,|-|-|-|-|v|-|-|^|-|-|v|-|-|-|-|.| | | | | | | | | |}}
+{{familytree | D04 | | | D05 | | | | D06 | | | D07| |D04=Syncope|D05=Epileptic seizure|D06=Psychogenic|D07=Rare causes}}
+{{familytree | |!| | | | |!| | | | | |!| | | | | | | | | | | | | | |}}
+{{familytree | B04 | | | B05 | | | | B06 | | | | | | | | | | | | |B04=• Reflex syncope<br>• [[Orthostatic hypotension]]<br>• [[Cardiac]] syncope|B05=• Tonic<br>• Clonic<br>• Tonic-clonic<br>• Atonic|B06=• Pseudo-epileptic<br>• Pseudo-syncopal}}
+{{familytree/end}}
+<small><small>
+'''Abbreviations:''' '''SCD''': Sudden cardiac death;'''T-LOC''': Transient-Loss of consciousness.
+</small></small>
+{|
+! colspan="2" style="background:#DCDCDC;" align="center" + |The above algorithm adopted from ESC guideline <ref name="MoyaSutton2009">{{cite journal|last1=Moya|first1=A.|last2=Sutton|first2=R.|last3=Ammirati|first3=F.|last4=Blanc|first4=J.-J.|last5=Brignole|first5=M.|last6=Dahm|first6=J. B.|last7=Deharo|first7=J.-C.|last8=Gajek|first8=J.|last9=Gjesdal|first9=K.|last10=Krahn|first10=A.|last11=Massin|first11=M.|last12=Pepi|first12=M.|last13=Pezawas|first13=T.|last14=Granell|first14=R. R.|last15=Sarasin|first15=F.|last16=Ungar|first16=A.|last17=van Dijk|first17=J. G.|last18=Walma|first18=E. P.|last19=Wieling|first19=W.|last20=Abe|first20=H.|last21=Benditt|first21=D. G.|last22=Decker|first22=W. W.|last23=Grubb|first23=B. P.|last24=Kaufmann|first24=H.|last25=Morillo|first25=C.|last26=Olshansky|first26=B.|last27=Parry|first27=S. W.|last28=Sheldon|first28=R.|last29=Shen|first29=W. K.|last30=Vahanian|first30=A.|last31=Auricchio|first31=A.|last32=Bax|first32=J.|last33=Ceconi|first33=C.|last34=Dean|first34=V.|last35=Filippatos|first35=G.|last36=Funck-Brentano|first36=C.|last37=Hobbs|first37=R.|last38=Kearney|first38=P.|last39=McDonagh|first39=T.|last40=McGregor|first40=K.|last41=Popescu|first41=B. A.|last42=Reiner|first42=Z.|last43=Sechtem|first43=U.|last44=Sirnes|first44=P. A.|last45=Tendera|first45=M.|last46=Vardas|first46=P.|last47=Widimsky|first47=P.|last48=Auricchio|first48=A.|last49=Acarturk|first49=E.|last50=Andreotti|first50=F.|last51=Asteggiano|first51=R.|last52=Bauersfeld|first52=U.|last53=Bellou|first53=A.|last54=Benetos|first54=A.|last55=Brandt|first55=J.|last56=Chung|first56=M. K.|last57=Cortelli|first57=P.|last58=Da Costa|first58=A.|last59=Extramiana|first59=F.|last60=Ferro|first60=J.|last61=Gorenek|first61=B.|last62=Hedman|first62=A.|last63=Hirsch|first63=R.|last64=Kaliska|first64=G.|last65=Kenny|first65=R. A.|last66=Kjeldsen|first66=K. P.|last67=Lampert|first67=R.|last68=Molgard|first68=H.|last69=Paju|first69=R.|last70=Puodziukynas|first70=A.|last71=Raviele|first71=A.|last72=Roman|first72=P.|last73=Scherer|first73=M.|last74=Schondorf|first74=R.|last75=Sicari|first75=R.|last76=Vanbrabant|first76=P.|last77=Wolpert|first77=C.|last78=Zamorano|first78=J. L.|title=Guidelines for the diagnosis and management of syncope (version 2009): The Task Force for the Diagnosis and Management of Syncope of the European Society of Cardiology (ESC)|journal=European Heart Journal|volume=30|issue=21|year=2009|pages=2631–2671|issn=0195-668X|doi=10.1093/eurheartj/ehp298}}</ref>
+|-
+|}
+It can be difficult to distinguish a seizure from other conditions causing a collapse, abnormal movements or other seizure manifestations. A 2007 [[Evidence based medicine|evidence-based]] review from the [[American Academy of Neurology]] and the American Epilepsy Society recommends an [[electroencephalogram]] (EEG, brain wave activity) and brain imaging with [[CT scan]] or [[MRI scan]] in the work-up of adults presenting with a first apparently unprovoked seizure. [[Blood tests]], [[lumbar puncture]] or toxicology screening can be helpful in specific circumstances suggestive of an underlying cause like [[meningitis]] or [[drug overdose]], but there is insufficient evidence to support their routine use in the work-up of an adult with an apparently unprovoked first seizure.<ref name="AAS2007">Krumholz A, Wiebe S, Gronseth G, Shinnar S, Levisohn P, Ting T, Hopp J, Shafer P, Morris H, Seiden L, Barkley G, French J; Quality Standards Subcommittee of the American Academy of Neurology; American Epilepsy Society. Practice Parameter: evaluating an apparent unprovoked first seizure in adults (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Epilepsy Society. ''Neurology'' 2007; '''69(21)''': 1996-2007. PMID 18025394</ref>
+Differentiating a seizure from other conditions such as [[Fainting|syncope]] can be difficult. In addition, 5% of patients with a positive [[tilt table test]] may have seizure-like activity that seems to be due to [[cerebral hypoxia]].<ref name="pmid12963568">{{cite journal |author=Passman R, Horvath G, Thomas J, ''et al'' |title=Clinical spectrum and prevalence of neurologic events provoked by tilt table testing |journal=Arch. Intern. Med. |volume=163 |issue=16 |pages=1945-8 |year=2003 |pmid=12963568 |doi=10.1001/archinte.163.16.1945}}</ref>
+As seizures have a [[differential diagnosis]], it is common for patients to be simultaneously investigated for cardiac and endocrine causes. Checking [[glucose]] levels, for example, is a mandatory action in the management of seizures as [[hypoglycemia]] may cause seizures, and failure to administer glucose would be harmful to the patient. Other causes typically considered are [[Fainting|syncope]] and [[cardiac arrhythmia]]s, and occasionally, [[panic attack]]s and [[cataplexy]]. For more information, see [[non-epileptic seizures]].
+[[Neurosyphilis]] can present with seizures and must be differentiated from other causes of seizures.<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: #4479BA; color: #FFFFFF; text-align: center;"
+! rowspan="2" |<small>Diseases</small>
+! colspan="4" |<small>Symptoms
+! colspan="5" |<small>Physical Examination</small>
+! rowspan="2" |<small>Past medical history</small>
+! colspan="3" |<small>Diagnostic tests</small>
+! rowspan="2" |<small>Other Findings</small>
+|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
+!<small>Headache</small>
+!↓<small>LOC</small>
+!<small>Motor weakness</small>
+!<small>Abnormal sensory</small>
+!<small>Motor Deficit</small>
+!<small>Sensory deficit</small>
+!<small>Speech difficulty</small>
+!<small>Gait abnormality</small>
+!<small>Cranial nerves</small>
+!<small>CT /MRI</small>
+!<small>CSF Findings</small>
+!<small>Gold standard test</small>
+|-
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Meningitis]]
+| 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" |History of [[fever]] and [[malaise]]
+| style="background: #F5F5F5; padding: 5px;" | -
+| style="background: #F5F5F5; padding: 5px; text-align:center" |'''↑''' [[Leukocytes]],
+'''↑''' Protein
+↓ Glucose
+| style="background: #F5F5F5; padding: 5px;" |[[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>
+| style="background: #F5F5F5; padding: 5px;" |[[Fever]], [[Neck rigidity|neck]]
+[[Neck rigidity|rigidity]]
+|-
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Encephalitis]]
+| 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" |History of [[fever]] and [[malaise]]
+| style="background: #F5F5F5; padding: 5px text-align:center" | +
+| style="background: #F5F5F5; padding: 5px text-align:center" |'''↑''' [[Leukocytes]], ↓ Glucose
+| style="background: #F5F5F5; padding: 5px text-align:center" |CSF [[PCR]]
+| style="background: #F5F5F5; padding: 5px text-align:center" |[[Fever]], [[Seizure|seizures]], [[Focal neurologic signs|focal neurologic abnormalities]]
+|-
+|style="background: #DCDCDC; padding: 5px; text-align: center;" | [[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>
+|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" |[[Weight loss]], [[fatigue]]
+|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;" |MRI
+|style="background: #F5F5F5; padding: 5px;" |[[Cachexia]], gradual progression of symptoms
+|-
+|style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Hemorrhagic stroke]]
+|style="background: #F5F5F5; padding: 5px text-align:center" | +
+|style="background: #F5F5F5; padding: 5px text-align:center" | +
+|style="background: #F5F5F5; padding: 5px text-align:center" | +
+|style="background: #F5F5F5; padding: 5px text-align:center" | +
+|style="background: #F5F5F5; padding: 5px text-align:center" | +
+|style="background: #F5F5F5; padding: 5px text-align:center" | +
+|style="background: #F5F5F5; padding: 5px text-align:center" | +
+|style="background: #F5F5F5; padding: 5px text-align:center" | +
+|style="background: #F5F5F5; padding: 5px text-align:center" | -
+|style="background: #F5F5F5; padding: 5px text-align:center" |[[Hypertension]]
+|style="background: #F5F5F5; padding: 5px; text-align:center" | +
+| style="background: #F5F5F5; padding: 5px;" | -
+|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;" |[[Neck stiffness]]
+|-
+|style="background: #DCDCDC; padding: 5px; text-align: center;" | [[Subdural hematoma|Subdural hemorrhage]]
+|style="background: #F5F5F5; padding: 5px text-align:center" | +
+|style="background: #F5F5F5; padding: 5px text-align:center" | +
+|style="background: #F5F5F5; padding: 5px text-align:center" | +
+|style="background: #F5F5F5; padding: 5px text-align:center" | +
+|style="background: #F5F5F5; padding: 5px text-align:center" | +
+|style="background: #F5F5F5; padding: 5px text-align:center" | -
+|style="background: #F5F5F5; padding: 5px text-align:center" | -
+|style="background: #F5F5F5; padding: 5px text-align:center" | -
+|style="background: #F5F5F5; padding: 5px text-align:center" | +
+|style="background: #F5F5F5; padding: 5px text-align:center" |[[Trauma]], fall
+|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;" |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;" |[[Confusion]], [[dizziness]], [[nausea]], [[vomiting]]
+|-
+|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 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" |[[Sexually transmitted disease|STI]]<nowiki/>s
+|style="background: #F5F5F5; padding: 5px; text-align:center" | +
+|style="background: #F5F5F5; padding: 5px;" |'''↑''' [[Leukocytes]] and [[protein]]
+|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;" |[[Blindness]], [[confusion]], [[depression]],
+Abnormal [[gait]]
+|-
+|style="background: #DCDCDC; padding: 5px; text-align: center;" |Complex or atypical [[migraine]]
+|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" |Family history of [[migraine]]
+| style="background: #F5F5F5; padding: 5px;" | -
+| style="background: #F5F5F5; padding: 5px;" | -
+|style="background: #F5F5F5; padding: 5px;" |Clinical assesment
+|style="background: #F5F5F5; padding: 5px;" |Presence of aura, [[nausea]], [[vomiting]]
+|-
+|style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Hypertensive encephalopathy]]
+|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" |[[Hypertension]]
+|style="background: #F5F5F5; padding: 5px;" | +
+|style="background: #F5F5F5; padding: 5px;" | -
+|style="background: #F5F5F5; padding: 5px;" |Clinical assesment
+|style="background: #F5F5F5; padding: 5px;" |[[Delirium]], [[cortical blindness]], [[cerebral edema]], [[seizure]]
+|-
+|style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Wernicke's encephalopathy|Wernicke’s encephalopathy]]
+|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" |History of alcohal abuse
+| style="background: #F5F5F5; padding: 5px;" | -
+| style="background: #F5F5F5; padding: 5px;" | -
+| style="background: #F5F5F5; padding: 5px;" |Clinical assesment and lab findings
+|style="background: #F5F5F5; padding: 5px;" |[[Ophthalmoplegia]], [[confusion]]
+|-
+|style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Brain abscess|CNS abscess]]
+|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" |History of [[drug abuse]], [[endocarditis]], [[immunosupression]]
+|style="background: #F5F5F5; padding: 5px;" | +
+|style="background: #F5F5F5; padding: 5px;" |'''↑''' leukocytes, '''↓''' glucose and '''↑''' protien
+|style="background: #F5F5F5; padding: 5px;" |MRI is more sensitive and specific
+|style="background: #F5F5F5; padding: 5px;" |High grade [[fever]], [[fatigue]],[[nausea]], [[vomiting]]
+|-
+|style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Drug toxicity]]
+|style="background: #F5F5F5; padding: 5px text-align:center" | -
+|style="background: #F5F5F5; padding: 5px text-align:center" | +
+|style="background: #F5F5F5; padding: 5px text-align:center" | -
+|style="background: #F5F5F5; padding: 5px text-align:center" | +
+|style="background: #F5F5F5; padding: 5px text-align:center" | +
+|style="background: #F5F5F5; padding: 5px text-align:center" | +
+|style="background: #F5F5F5; padding: 5px text-align:center" | -
+|style="background: #F5F5F5; padding: 5px text-align:center" | +
+|style="background: #F5F5F5; padding: 5px text-align:center" | -
+|style="background: #F5F5F5; padding: 5px text-align:center" | -
+| style="background: #F5F5F5; padding: 5px;" | -
+| style="background: #F5F5F5; padding: 5px;" | -
+| style="background: #F5F5F5; padding: 5px;" |Drug screen test
+|style="background: #F5F5F5; padding: 5px;" |[[Lithium]], [[Sedatives]], [[phenytoin]], [[carbamazepine]]
+|-
+|style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Conversion disorder]]
+|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" |History of [[emotional stress]]
+| style="background: #F5F5F5; padding: 5px;" | -
+| style="background: #F5F5F5; padding: 5px;" | -
+|style="background: #F5F5F5; padding: 5px;" |Diagnosis of exclusion
+|style="background: #F5F5F5; padding: 5px;" |[[Tremor|Tremors]], [[blindness]], difficulty [[swallowing]]
+|-
+|style="background: #DCDCDC; padding: 5px; text-align: center;" |Metabolic disturbances ([[electrolyte imbalance]], [[hypoglycemia]])
+|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;" |[[Hypoglycemia]], [[Hyponatremia|hypo]] and [[hypernatremia]], [[Hypokalemia|hypo]] and [[hyperkalemia]]
+|style="background: #F5F5F5; padding: 5px;" |Depends on the cause
+| style="background: #F5F5F5; padding: 5px;" |[[Confusion]], [[seizure]], [[Palpitation|palpitations]], [[sweating]], [[dizziness]], [[hypoglycemia]]
+|-
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Multiple sclerosis]] exacerbation
+|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" |History of relapses and remissions
+| style="background: #F5F5F5; padding: 5px; text-align:center" | +
+| style="background: #F5F5F5; padding: 5px; text-align:center" |'''↑'''  CSF IgG levels
+(monoclonal bands)
+| style="background: #F5F5F5; padding: 5px;" |Clinical assesment and [[MRI]] <ref name="pmid8274111">{{cite journal| author=Giang DW, Grow VM, Mooney C, Mushlin AI, Goodman AD, Mattson DH et al.| title=Clinical diagnosis of multiple sclerosis. The impact of magnetic resonance imaging and ancillary testing. Rochester-Toronto Magnetic Resonance Study Group. | journal=Arch Neurol | year= 1994 | volume= 51 | issue= 1 | pages= 61-6 | pmid=8274111 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8274111  }}</ref>
+| style="background: #F5F5F5; padding: 5px;" |[[Blurred vision|Blurry vision]], [[urinary incontinence]], [[fatigue]]
+|-
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Seizure]]
+|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" |Previous history of [[seizures]]
+| style="background: #F5F5F5; padding: 5px;" | -
+| style="background: #F5F5F5; padding: 5px;" |Mass lesion
+| style="background: #F5F5F5; padding: 5px;" |Clinical assesment and [[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>
+| style="background: #F5F5F5; padding: 5px;" |[[Confusion]], [[apathy]], [[irritability]],
+|}
 ==References==
 {{reflist|2}}
-{{WH}}
+[[Category:Neurology]]
-{{WS}}
+[[Category:Epilepsy]]
+[[Category:Emergency medicine]]
+[[Category:Disease]]

Seizure differential diagnosis: Difference between revisions

Latest revision as of 17:36, 26 December 2020

Overview

Differentiating Seizure from other Conditions

References

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