Subdural empyema differential diagnosis: Difference between revisions

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Latest revision as of 18:53, 18 September 2017

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2]; Anthony Gallo, B.S. [3]

Overview

Subdural empyema must be differentiated from other diseases that cause fever, headache, focal neurological signs, seizures, and altered mental status, such as subdural hematoma, brain abscess, and bacterial meningitis. These conditions may be distinguished from subdural empyema by their clinical findings, brain imaging findings, and laboratory studies.

Differential Diagnosis

Subdural empyema must be differentiated from other diseases that cause fever, headache, focal neurological signs, seizures, and altered mental status, including:^[1]^[2]


Disease	Findings
Subdural hematoma	Presents with an accumulation of blood in the subdural space, which frequently surges in the presence of trauma; it may cause an increase of intracranial pressure causing compression and damage to the brain. The acute form of this condition is considered a medical emergency.
Brain abscess	Presents with an abscess in the brain caused by the inflammation and accumulation of infected material from local or remote infectious areas of the body; the infectious agent may also be introduced as a result of head trauma or neurological procedures.
Bacterial meningitis	Presents with inflammation of the meninges, which may develop in the setting of an infection, physical injury, cancer, or certain drugs; it may have an indolent evolution, resolving on its own, or may present as an rapidly evolving inflammation, causing neurologic damage and possible mortality.
Viral encephalitis	Presents with acute inflammation of the brain, caused by a viral infection; it may complicate into severe brain damage as the inflamed brain pushes against the skull, potentially leading to mortality.
Epidural abscess	Presents with an abscess in the epidural space, between the vertebrae and the dura mater of the spinal canal; it may complicate into spinal cord dysfunction, leading to paralysis.
Cerebral thrombophlebitis	Presents with inflammation of a cerebral vein, related to a blood clot or thrombus; it can cause chronic pain, leg swelling, and pulmonary embolism.
Superior sagittal sinus thrombosis	Presents with thrombosis affecting the dural venous sinuses, which drain blood from the brain; it can cause headaches, fever, and increased intracranial pressure.
Acute disseminated encephalomyelitis	Presents with scattered foci of demyelination and perivenular inflammation; it can cause focal neurological signs and decreased ability to focus.

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^[3]^[4]		✔	Cancer cells^[5]	MRI		✔	✔	✔	✔	✔		✔		Cachexia, gradual progression of symptoms
Delirium tremens		✔		Clinical diagnosis		✔	✔		✔	✔	✔	✔	Alcohol intake, sudden witdrawl or reduction in consumption	Tachycardia, diaphoresis, hypertension, tremors, mydriasis, positional nystagmus,
Subarachnoid hemorrhage^[6]		✔	Xanthochromia^[7]	CT scan without contrast^[8]^[9]	✔	✔	✔	✔	✔	✔	✔	✔	Trauma/fall	Confusion, dizziness, nausea, vomiting
Stroke		✔	Normal	CT scan without contrast		✔	✔		✔	✔		✔	TIAs, hypertension, diabetes mellitus	Speech difficulty, gait abnormality
Neurosyphilis^[10]^[11]		✔	↑ Leukocytes and protein	CSF VDRL-specifc CSF FTA-Ab -sensitive^[12]	✔	✔	✔	✔		✔		✔	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 convulsion			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

References

↑ Agrawal, Amit; Timothy, Jake; Pandit, Lekha; Shetty, Lathika; Shetty, J.P. (2007). "A Review of Subdural Empyema and Its Management". Infectious Diseases in Clinical Practice. 15 (3): 149–153. doi:10.1097/01.idc.0000269905.67284.c7. ISSN 1056-9103.
↑ Longo, Dan L. (Dan Louis) (2012). Harrison's principles of internal medici. New York: McGraw-Hill. ISBN 978-0-07-174889-6.
↑ Soffer D (1976) Brain tumors simulating purulent meningitis. Eur Neurol 14 (3):192-7. PMID: 1278192
↑
↑ 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.
↑ 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
↑ Lee MC, Heaney LM, Jacobson RL, Klassen AC (1975). "Cerebrospinal fluid in cerebral hemorrhage and infarction". Stroke. 6 (6): 638–41. PMID 1198628.
↑ 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.

Template:WH Template:WS

[AgrawalTimothy2007-1] Agrawal, Amit; Timothy, Jake; Pandit, Lekha; Shetty, Lathika; Shetty, J.P. (2007). "A Review of Subdural Empyema and Its Management". Infectious Diseases in Clinical Practice. 15 (3): 149–153. doi:10.1097/01.idc.0000269905.67284.c7. ISSN 1056-9103.

[2] Longo, Dan L. (Dan Louis) (2012). Harrison's principles of internal medici. New York: McGraw-Hill. ISBN 978-0-07-174889-6.

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

[pmid3883130-4] ↑

[pmid21371327-5] 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.

[pmid14585453-6] 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

[pmid1198628-7] Lee MC, Heaney LM, Jacobson RL, Klassen AC (1975). "Cerebrospinal fluid in cerebral hemorrhage and infarction". Stroke. 6 (6): 638–41. PMID 1198628.

[pmid21694755-8] Birenbaum D, Bancroft LW, Felsberg GJ (2011). "Imaging in acute stroke". West J Emerg Med. 12 (1): 67–76. PMC 3088377. PMID 21694755.

[pmid21807345-9] DeLaPaz RL, Wippold FJ, Cornelius RS, Amin-Hanjani S, Angtuaco EJ, Broderick DF; et al. (2011). "ACR Appropriateness Criteria® on cerebrovascular disease". J Am Coll Radiol. 8 (8): 532–8. doi:10.1016/j.jacr.2011.05.010. PMID 21807345.

[pmid22482824-10] 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.

[pmid24365430-11] Berger JR, Dean D (2014). "Neurosyphilis". Handb Clin Neurol. 121: 1461–72. doi:10.1016/B978-0-7020-4088-7.00098-5. PMID 24365430.

[pmid22421697-12] 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.

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@@ Line 1: / Line 1: @@
 __NOTOC__
 {{Subdural empyema}}
-{{CMG}}; {{AE}} {{JS}}
+{{CMG}} {{AE}} {{JS}}; {{AG}}
 ==Overview==
-Subdural empyema, also referred to as [[subdural abscess]], [[pachymeningitis interna]] and [[circumscript meningitis]], is a life-threatening [[infection]].<ref name="AgrawalTimothy2007">{{cite journal|last1=Agrawal|first1=Amit|last2=Timothy|first2=Jake|last3=Pandit|first3=Lekha|last4=Shetty|first4=Lathika|last5=Shetty|first5=J.P.|title=A Review of Subdural Empyema and Its Management|journal=Infectious Diseases in Clinical Practice|volume=15|issue=3|year=2007|pages=149–153|issn=1056-9103|doi=10.1097/01.idc.0000269905.67284.c7}}</ref> It consists of a localised collection of [[pus|purulent]] material, usually unilateral, between the [[dura mater]] and the [[arachnoid mater]] and accounts for about 15-22% of the reported focal intracranial [[infections]]  The [[empyema]] may develop intracranially (about 95%) or in the [[spinal canal]] (about 5%), and in both cases, it constitutes a [[medical emergency|medical]] and [[surgical emergency|neurosurgical emergency]].<ref name="pmid12521560">{{cite journal| author=Greenlee JE| title=Subdural Empyema. | journal=Curr Treat Options Neurol | year= 2003 | volume= 5 | issue= 1 | pages= 13-22 | pmid=12521560 | doi= | pmc=|url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12521560  }} </ref>
+Subdural empyema must be differentiated from other diseases that cause [[fever]], [[headache]], focal neurological signs, [[seizures]], and [[altered mental status]], such as [[subdural hematoma]], [[brain abscess]], and [[bacterial meningitis]]. These conditions may be distinguished from subdural empyema by their clinical findings, brain imaging findings, and laboratory studies.
 ==Differential Diagnosis==
-The clinical features presented by a patient with subdural empyema, such as: [[fever]], [[headache]], focal neurological signs, [[seizures]] and altered mental status, are common to other pathologic conditions: <ref name="AgrawalTimothy2007">{{cite journal|last1=Agrawal|first1=Amit|last2=Timothy|first2=Jake|last3=Pandit|first3=Lekha|last4=Shetty|first4=Lathika|last5=Shetty|first5=J.P.|title=A Review of Subdural Empyema and Its Management|journal=Infectious Diseases in Clinical Practice|volume=15|issue=3|year=2007|pages=149–153|issn=1056-9103|doi=10.1097/01.idc.0000269905.67284.c7}}</ref><ref>{{Cite book  | last1 = Longo | first1 = Dan L. (Dan Louis) | title = Harrison's principles of internal medici | date = 2012 | publisher = McGraw-Hill | location = New York | isbn = 978-0-07-174889-6 | pages =  }}</ref>
+Subdural empyema must be differentiated from other diseases that cause [[fever]], [[headache]], focal neurological signs, [[seizures]], and [[altered mental status]], including:<ref name="AgrawalTimothy2007">{{cite journal|last1=Agrawal|first1=Amit|last2=Timothy|first2=Jake|last3=Pandit|first3=Lekha|last4=Shetty|first4=Lathika|last5=Shetty|first5=J.P.|title=A Review of Subdural Empyema and Its Management|journal=Infectious Diseases in Clinical Practice|volume=15|issue=3|year=2007|pages=149–153|issn=1056-9103|doi=10.1097/01.idc.0000269905.67284.c7}}</ref><ref>{{Cite book  | last1 = Longo | first1 = Dan L. (Dan Louis) | title = Harrison's principles of internal medici | date = 2012 | publisher = McGraw-Hill | location = New York | isbn = 978-0-07-174889-6 | pages =  }}</ref>
-*[[Subdural hematoma]] - accumulation of blood in the [[subdural space]], which frequently surges in the presence of trauma. It may cause an increase of [[intracranial pressure]]  causing compression and damage of the [[brain]]. The acute form of this condition is considered a [[medical emergency]].
-*[[Brain abscess]] - an [[abscess]] in the [[brain]]  caused by the [[inflammation]] and accumulation of [[infected]] material from local or remote infectious areas of the body. The infectious agent may also be introduced as a result of head trauma or neurological procedures.
+{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
+|+
+! style="background: #4479BA; width: 120px;" | {{fontcolor|#FFF|Disease}}
+! style="background: #4479BA; width: 550px;" | {{fontcolor|#FFF|Findings}}
+|-
+| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Subdural hematoma]]'''
+| style="padding: 5px 5px; background: #F5F5F5;" | Presents with an accumulation of [[blood]] in the [[subdural space]], which frequently surges in the presence of trauma; it may cause an increase of [[intracranial pressure]] causing compression and damage to the [[brain]]. The acute form of this condition is considered a [[medical emergency]].
+|-
+| style="padding: 5px 5px; background: #DCDCDC;" |'''[[Brain abscess]]'''
+| style="padding: 5px 5px; background: #F5F5F5;" |Presents with an [[abscess]] in the [[brain]] caused by the [[inflammation]] and accumulation of [[infected]] material from local or remote infectious areas of the body; the infectious agent may also be introduced as a result of head [[trauma]] or [[neurosurgery|neurological procedures]].
+|-
+| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Bacterial meningitis]]'''
+| style="padding: 5px 5px; background: #F5F5F5;" |Presents with [[inflammation]] of the [[meninges]], which may develop in the setting of an [[infection]], physical injury, [[cancer]], or certain drugs; it may have an indolent evolution, resolving on its own, or may present as an rapidly evolving [[inflammation]], causing neurologic damage and possible [[mortality]].
+|-
+| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Viral encephalitis]] '''
+| style="padding: 5px 5px; background: #F5F5F5;" | Presents with acute [[inflammation]] of the [[brain]], caused by a [[viral infection]]; it may complicate into severe [[brain]] damage as the inflamed [[brain]] pushes against the [[skull]], potentially leading to [[mortality]].
+|-
+| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Epidural abscess]]'''
+| style="padding: 5px 5px; background: #F5F5F5;" | Presents with an [[abscess]] in the [[epidural space]], between the [[vertebrae]] and the [[dura mater]] of the [[spinal canal]]; it may complicate into [[spinal cord]] dysfunction, leading to [[paralysis]].
+|-
+| style="padding: 5px 5px; background: #DCDCDC;" | '''Cerebral [[thrombophlebitis]]'''
+| style="padding: 5px 5px; background: #F5F5F5;" | Presents with [[inflammation]] of a cerebral [[vein]], related to a [[blood clot]] or [[thrombus]]; it can cause [[chronic pain]], leg [[swelling]], and [[pulmonary embolism]].
+|-
+| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Superior sagittal sinus thrombosis]]'''
+| style="padding: 5px 5px; background: #F5F5F5;" | Presents with [[thrombosis]] affecting the [[dural venous sinuses]], which drain blood from the [[brain]]; it can cause [[headache]]s, [[fever]], and increased [[intracranial pressure]].
+|-
+| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Acute disseminated encephalomyelitis]]'''
+| style="padding: 5px 5px; background: #F5F5F5;" | Presents with scattered foci of [[demyelination]] and perivenular [[inflammation]]; it can cause focal neurological signs and decreased ability to focus.
+|-
+|}
-*[[Bacterial meningitis]] - [[inflammation]] of the [[meninges]]  which may develop in the setting of an [[infection]] ([[bacterial]], [[viruses]],  [[fungi]] or other organisms), physical injury, [[cancer]] or certain drugs. It may have an indolent evolution, resolving on its own, or may present as an rapidly evolving [[inflammation]], causing neurologic a damage and potentially death.
-*[[Viral encephalitis]] -  acute [[inflammation]] of the [[brain]], caused by a [[viral infection]]. It may complicate into severe [[brain]] damage as the inflamed [[brain]] pushes against the [[skull]], potentially leading to death.
-*[[Epidural abscess]] - an [[abscess]] in the [[epidural space]], between the [[vertebrae]] and the [[dura mater]] of the [[spinal canal]].
-*Cerebral [[thrombophlebitis]] - [[inflammation]] of a cerebral [[vein]], related to a [[blood clot]] or [[thrombus]].
+{|
-*[[Superior sagittal sinus]] [[thrombosis]]
+|-style="background: #4479BA; color: #FFFFFF; text-align: center;"
-*[[Acute disseminated encephalomyelitis]]
+! rowspan="2" |<small>Diseases</small>
-*Acute necrotising hemorrhagic leukoencephalopathy
+! colspan="4" |<small>Diagnostic tests</small>
-*Focal embolic encephalomalacia due to [[bacterial endocarditis]]
+! colspan="5" |<small>Physical Examination</small>
+! colspan="3" |<small>Symptoms
+! colspan="1" rowspan="2" |<small>Past medical history</small>
+! rowspan="2" |<small>Other Findings</small>
+|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
+!<small>Na+, K+, Ca2+</small>
+!<small>CT /MRI</small>
+!<small>CSF Findings</small>
+!<small>Gold standard test</small>
+!<small>Neck stiffness</small>
+!<small>Motor or Sensory deficit</small>
+!<small>Papilledema</small>
+!<small>Bulging fontanelle</small>
+!<small>Cranial nerves</small>
+!<small>Headache</small>
+!<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: #F5F5F5; padding: 5px;" |
+|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; 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;" |[[Cachexia]], gradual progression of symptoms
+|-
+|style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Delirium tremens]]
+|style="background: #F5F5F5; padding: 5px;" |
+|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" |✔
+| 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;" |[[Alcohol]] intake, sudden witdrawl or reduction in consumption
+|style="background: #F5F5F5; padding: 5px;" |[[Tachycardia]], [[diaphoresis]], [[hypertension]], [[tremors]], [[mydriasis]], [[positional nystagmus]],
+|-
+|style="background: #DCDCDC; padding: 5px; text-align: center;" | [[Subarachnoid hemorrhage|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; 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; 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;" |[[Confusion]], [[dizziness]], [[Nausea and vomiting|nausea]], [[Nausea and vomiting|vomiting]]
+|-
+|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"| Normal
+|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"|TIAs, [[hypertension]], [[diabetes mellitus]]
+|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: #F5F5F5; padding: 5px;" |
+|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; 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; text-align:center" |✔
+|style="background: #F5F5F5; padding: 5px;" |
+|style="background: #F5F5F5; padding: 5px; text-align:center" |✔
+|style="background: #F5F5F5; padding: 5px;" |Unprotected sexual intercourse, [[STI]]<nowiki/>s
+|style="background: #F5F5F5; padding: 5px;" |[[Blindness]], [[confusion]], [[depression]],
+Abnormal [[gait]]
+|-
+|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;" |Increased [[RBC]]S or xanthochromia, [[Mononuclear cells|mononuclear]] [[lymphocytosis]], high protein content, normal [[glucose]]
+|style="background: #F5F5F5; padding: 5px;" |Clinical assesment
+|style="background: #F5F5F5; padding: 5px;" |✔
+|style="background: #F5F5F5; padding: 5px;" |✔
+|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;" |✔
+|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: #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;" |
+|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;" |[[Delirium]], cortical [[blindness]], [[cerebral edema]], [[seizure]]
+|-
+|style="background: #DCDCDC; padding: 5px; text-align: center;" |Wernicke’s encephalopathy
+|style="background: #F5F5F5; padding: 5px;" |
+|style="background: #F5F5F5; padding: 5px;" |
+|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;" |History of alcohal abuse
+|style="background: #F5F5F5; padding: 5px;" |[[Ophthalmoplegia]], [[confusion]]
+|-
+|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;" |'''↑''' [[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,
+[[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;" |History of [[drug abuse]], [[endocarditis]], '''↓''' [[immune]] status
+|style="background: #F5F5F5; padding: 5px;" |High grade [[fever]], [[fatigue]],[[Nausea and vomiting|nausea]], [[vomiting]]
+|-
+|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;" |[[Lithium]], Sedatives, [[phenytoin]], [[carbamazepine]]
+|-
+|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;" |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;" |
+| 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;" |[[Tremor|Tremors]], [[blindness]], difficulty [[swallowing]]
+|-
+|style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Electrolyte disturbance]]
+|style="background: #F5F5F5; padding: 5px; text-align:center" |'''↓''' or '''↑'''
+|style="background: #F5F5F5; padding: 5px;" |
+|style="background: #F5F5F5; padding: 5px;" |
+|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;" |[[Confusion]], [[Seizure|seizures]]
+|-
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Febrile convulsion]]
+| style="background: #F5F5F5; padding: 5px;" |
+| style="background: #F5F5F5; padding: 5px;" |
+| style="background: #F5F5F5; padding: 5px; text-align:center" |Not performed in first simple febrile [[seizures]]
+| style="background: #F5F5F5; padding: 5px;" |Clinical diagnosis and EEG
+| 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;" |Family history of [[febrile]] [[seizures]], [[viral]] illness or [[gastroenteritis]]
+| style="background: #F5F5F5; padding: 5px;" |Age > 1 month,
+|-
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Subdural empyema]]
+| 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;" |Clinical assesment and [[MRI]]
+| 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;" |
+| style="background: #F5F5F5; padding: 5px;" |
+| style="background: #F5F5F5; padding: 5px; text-align:center" |✔
+| style="background: #F5F5F5; padding: 5px;" |History of relapses and remissions
+| style="background: #F5F5F5; padding: 5px;" |Blurry vision, [[urinary incontinence]], [[fatigue]]
+|-
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Hypoglycemia]]
+| style="background: #F5F5F5; padding: 5px; text-align:center" |↓ or '''↑'''
+| style="background: #F5F5F5; padding: 5px;" |
+| style="background: #F5F5F5; padding: 5px;" |
+| style="background: #F5F5F5; padding: 5px;" |Serum blood [[Glucose-1-phosphate adenylyltransferase|glucose]]
+[[HbA1c]]
+| 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; text-align:center" |  ✔
+| style="background: #F5F5F5; padding: 5px; text-align:center" |
+| style="background: #F5F5F5; padding: 5px;" |✔
+| style="background: #F5F5F5; padding: 5px;" |History of [[Diabetes mellitus|diabetes]]
+| style="background: #F5F5F5; padding: 5px;" |[[Palpitation|Palpitations]], [[sweating]], [[dizziness]], low serum, [[glucose]]
+|}
 ==References==
 {{Reflist|2}}
-[[Category:Needs content]]
-[[Category:Infectious disease]]
 {{WH}}
 {{WS}}

Subdural empyema differential diagnosis: Difference between revisions

Latest revision as of 18:53, 18 September 2017

Overview

Differential Diagnosis

References

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