Tetanus differential diagnosis: Difference between revisions

	Tetanus Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Tetanus from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
History and Symptoms
Physical Examination
Laboratory Findings
Xray
CT scan
MRI
Ultrasound
Other Imaging Studies
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Tetanus differential diagnosis On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Tetanus differential diagnosis All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Tetanus differential diagnosis
CDC on Tetanus differential diagnosis
Tetanus differential diagnosis in the news
Blogs on Tetanus differential diagnosis
Directions to Hospitals Treating Tetanus
Risk calculators and risk factors for Tetanus differential diagnosis

VisualWikitext

Revision as of 19:43, 12 June 2017

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Michael Maddaleni, B.S.; Associate Editor(s)-in-Chief: Usama Talib, BSc, MD [2]

Overview

Tetanus must be differentiated from strychnine poisoning, dental infections, drug reactions, hypocalcemia, meningitis, stroke and stiff man syndrome.^[1]

Differentiating Tetanus from other Diseases

Some of the other diseases that need to be considered when trying to diagnose tetanus include:^[2]^[3]^[4]

Differential for Unilateral Involuntary Face Movements

The differential diagnosis for abnormal one sided movements of the face includes:^[5]^[6]^[7]^[8]^[9]^[10]^[11]^[12]^[13]^[14]^[15]

Tetanus associated trismus
Temporomandibular joint (TMJ) dysfunction
Tetany
Unilateral jaw dystonia
Exclusive facial myokymia
Exclusive hemifacial spasm
Multiple sclerosis (MS) associated tonic spasms
Focal motor epilepsy
Hemimasticatory spasm in the presence or absence hemiatrophy of the face

**Differential Diagnosis of Tetanus**
Disease	Diagnosis			Treatment
Disease	Symptoms	Signs	Laboratory Findings	Treatment
Tetanus	Tonic contraction of muscles between the spasmodic episodes Trismus or lockjaw Neck stiffness Swallowing difficulty Stiffening of the calf and pectoral muscle groups	Opisthotonos Leg extension with arm flexion Risus sardonicus respiratory distress	Not significant	Diazepam Magnesium Human TIG
Neuroleptic Malignant Syndrome	History of intake of offending drugs e.g neuroleptics like: Fluphenazine Haloperidol Risperidone Autonomic instability Rigidity Disorientation Fever	Dysphagia Pallor Dyspnea Shuffling gait Agitation	Myoglobinemia Elevated LDH Elevated creatine kinase Hyperkalemia Elevated AST and ALT Hyperphosphatemia Elevated alkaline phosphatase Hyperuricemia	Supportive therapy Stop the offending agent Medical Therapy Dantrolene Amantadine Bromocriptine
Viral Meningitis^[16]^[17]	Fever Irritability Lack of appetite Lethargy Disoriented High grade fever Severe headache Stiff neck Sensitivity to bright light Nausea Vomiting	Headache Photophobia Phonophopia Pharyngitis in case of enterovirus infeciton Orchitis (In mumps) Vesicular or macular skin rash Petichiae Nuchal rigidity Signs of meningeal irritation: Kernig's sign Brudzinski's sign Altered mental status Hypotonia	CSF/plasma glucose ratio (>0.6) Lactate (mmols/l) (<2.1) Lymphocytes>granulocytes	Supportive Analgesics for pain. Acetaminophen for fever. Anti-viral therapy: Acyclovir ^[2] Pleconaril
Stiff man syndrome	Marked rigidity Spasms Intermittent Painful Absent during sleep	Diaphoresis Arterial hypertension Tachypnea Cyanosis Apnea, tachypnea Respiratory arrest Dilatation of the pupils Tachycardia	CSF has Elevated IgG Oligoclonal bands Positive anti-GAD antibodies Elevated creatine kinase Normal CBC & ESR	Benzodiazepines Baclofen Vigabatrin Valproic Acid, Neurontin Injected botulinum toxin Prednisone, plasmapheresis, IVIG ( some success)
Drug induced	History of intake of the offending drug Eye deviation Head and neck jerky movements No tonic contraction of the muscles between the spasms			Stop the offending agent Benztropine
Strychnine poisoning^[18]^[19]	Proper tetanus immunizations History of intentional or accidental intake		Blood assay
Hypocalcaemia
Dental abscess
Parkinson's disease

References

↑ Anisha Doshi, Clare Warrell, Dima Dahdaleh & Dimitri Kullmann (2014). "Just a graze? Cephalic tetanus presenting as a stroke mimic". Practical neurology. 14 (1): 39–41. doi:10.1136/practneurol-2013-000541. PMID 24052566. Unknown parameter |month= ignored (help)
↑ E. Andreadou, E. Kattoulas, C. Sfagos & D. Vassilopoulos (2007). "Stiff person syndrome: avoiding misdiagnosis". Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology. 28 (1): 35–37. doi:10.1007/s10072-007-0745-9. PMID 17385093. Unknown parameter |month= ignored (help)
↑ Lisa Mitchell, William Adams & Francois Aspesberro (2017). "Case 6: Episodic Stiffness in a 30-month-old Girl". Pediatrics in review. 38 (1): 52–53. doi:10.1542/pir.2014-0142. PMID 28044038. Unknown parameter |month= ignored (help)
↑ P. D. Thompson, J. A. Obeso, G. Delgado, J. Gallego & C. D. Marsden (1986). "Focal dystonia of the jaw and the differential diagnosis of unilateral jaw and masticatory spasm". Journal of neurology, neurosurgery, and psychiatry. 49 (6): 651–656. PMID 3734821. Unknown parameter |month= ignored (help)
↑ P. D. Thompson, J. A. Obeso, G. Delgado, J. Gallego & C. D. Marsden (1986). "Focal dystonia of the jaw and the differential diagnosis of unilateral jaw and masticatory spasm". Journal of neurology, neurosurgery, and psychiatry. 49 (6): 651–656. PMID 3734821. Unknown parameter |month= ignored (help)
↑ J. R. Berger, W. A. Sheremata & E. Melamed (1984). "Paroxysmal dystonia as the initial manifestation of multiple sclerosis". Archives of neurology. 41 (7): 747–750. PMID 6743065. Unknown parameter |month= ignored (help)
↑ W. B. Matthews (1975). "Paroxysmal symptoms in multiple sclerosis". Journal of neurology, neurosurgery, and psychiatry. 38 (6): 617–623. PMID 1151430. Unknown parameter |month= ignored (help)
↑ P. D. Thompson & W. M. Carroll (1983). "Hemimasticatory spasm--a peripheral paroxysmal cranial neuropathy?". Journal of neurology, neurosurgery, and psychiatry. 46 (3): 274–276. PMID 6842234. Unknown parameter |month= ignored (help)
↑ P. D. Thompson & W. M. Carroll (1983). "Hemimasticatory and hemifacial spasm: a common pathophysiology?". Clinical and experimental neurology. 19: 110–119. PMID 6568919.
↑ L. R. Jenkyn, D. B. Walsh, C. M. Culver & A. G. Reeves (1977). "Clinical signs in diffuse cerebral dysfunction". Journal of neurology, neurosurgery, and psychiatry. 40 (10): 956–966. PMID 591973. Unknown parameter |month= ignored (help)
↑ J. D. Rugh & W. K. Solberg (1976). "Psychological implications in temporomandibular pain and dysfunction". Oral sciences reviews. 7: 3–30. PMID 775369.
↑ Bond WS (1984). "Detection and management of the neuroleptic malignant syndrome". Clin Pharm. 3 (3): 302–7. PMID 6145537.
↑ S. Fahn, S. B. Bressman & C. D. Marsden (1998). "Classification of dystonia". Advances in neurology. 78: 1–10. PMID 9750897.
↑ Howard L. Geyer & Susan B. Bressman (2006). "The diagnosis of dystonia". The Lancet. Neurology. 5 (9): 780–790. doi:10.1016/S1474-4422(06)70547-6. PMID 16914406. Unknown parameter |month= ignored (help)
↑ Christine Klein & Laurie J. Ozelius (2002). "Dystonia: clinical features, genetics, and treatment". Current opinion in neurology. 15 (4): 491–497. PMID 12151848. Unknown parameter |month= ignored (help)
↑ Chow E, Troy SB (2014). "The differential diagnosis of hypoglycorrhachia in adult patients". Am J Med Sci. 348 (3): 186–90. doi:10.1097/MAJ.0000000000000217. PMC 4065645. PMID 24326618.
↑ Leen WG, Willemsen MA, Wevers RA, Verbeek MM (2012). "Cerebrospinal fluid glucose and lactate: age-specific reference values and implications for clinical practice". PLoS One. 7 (8): e42745. doi:10.1371/journal.pone.0042745. PMC 3412827. PMID 22880096.
↑ Charlotte Duverneuil, Geoffroy Lorin de la Grandmaison, Philippe de Mazancourt & Jean-Claude Alvarez (2004). "Liquid chromatography/photodiode array detection for determination of strychnine in blood: a fatal case report". Forensic science international. 141 (1): 17–21. doi:10.1016/j.forsciint.2003.12.010. PMID 15066709. Unknown parameter |month= ignored (help)
↑ B. A. Smith (1990). "Strychnine poisoning". The Journal of emergency medicine. 8 (3): 321–325. PMID 2197324. Unknown parameter |month= ignored (help)

Template:WH Template:WS

[1] Anisha Doshi, Clare Warrell, Dima Dahdaleh & Dimitri Kullmann (2014). "Just a graze? Cephalic tetanus presenting as a stroke mimic". Practical neurology. 14 (1): 39–41. doi:10.1136/practneurol-2013-000541. PMID 24052566. Unknown parameter |month= ignored (help)

[2] E. Andreadou, E. Kattoulas, C. Sfagos & D. Vassilopoulos (2007). "Stiff person syndrome: avoiding misdiagnosis". Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology. 28 (1): 35–37. doi:10.1007/s10072-007-0745-9. PMID 17385093. Unknown parameter |month= ignored (help)

[3] Lisa Mitchell, William Adams & Francois Aspesberro (2017). "Case 6: Episodic Stiffness in a 30-month-old Girl". Pediatrics in review. 38 (1): 52–53. doi:10.1542/pir.2014-0142. PMID 28044038. Unknown parameter |month= ignored (help)

[4] P. D. Thompson, J. A. Obeso, G. Delgado, J. Gallego & C. D. Marsden (1986). "Focal dystonia of the jaw and the differential diagnosis of unilateral jaw and masticatory spasm". Journal of neurology, neurosurgery, and psychiatry. 49 (6): 651–656. PMID 3734821. Unknown parameter |month= ignored (help)

[5] P. D. Thompson, J. A. Obeso, G. Delgado, J. Gallego & C. D. Marsden (1986). "Focal dystonia of the jaw and the differential diagnosis of unilateral jaw and masticatory spasm". Journal of neurology, neurosurgery, and psychiatry. 49 (6): 651–656. PMID 3734821. Unknown parameter |month= ignored (help)

[6] J. R. Berger, W. A. Sheremata & E. Melamed (1984). "Paroxysmal dystonia as the initial manifestation of multiple sclerosis". Archives of neurology. 41 (7): 747–750. PMID 6743065. Unknown parameter |month= ignored (help)

[7] W. B. Matthews (1975). "Paroxysmal symptoms in multiple sclerosis". Journal of neurology, neurosurgery, and psychiatry. 38 (6): 617–623. PMID 1151430. Unknown parameter |month= ignored (help)

[8] P. D. Thompson & W. M. Carroll (1983). "Hemimasticatory spasm--a peripheral paroxysmal cranial neuropathy?". Journal of neurology, neurosurgery, and psychiatry. 46 (3): 274–276. PMID 6842234. Unknown parameter |month= ignored (help)

[9] P. D. Thompson & W. M. Carroll (1983). "Hemimasticatory and hemifacial spasm: a common pathophysiology?". Clinical and experimental neurology. 19: 110–119. PMID 6568919.

[10] L. R. Jenkyn, D. B. Walsh, C. M. Culver & A. G. Reeves (1977). "Clinical signs in diffuse cerebral dysfunction". Journal of neurology, neurosurgery, and psychiatry. 40 (10): 956–966. PMID 591973. Unknown parameter |month= ignored (help)

[11] J. D. Rugh & W. K. Solberg (1976). "Psychological implications in temporomandibular pain and dysfunction". Oral sciences reviews. 7: 3–30. PMID 775369.

[pmid6145537-12] Bond WS (1984). "Detection and management of the neuroleptic malignant syndrome". Clin Pharm. 3 (3): 302–7. PMID 6145537.

[13] S. Fahn, S. B. Bressman & C. D. Marsden (1998). "Classification of dystonia". Advances in neurology. 78: 1–10. PMID 9750897.

[14] Howard L. Geyer & Susan B. Bressman (2006). "The diagnosis of dystonia". The Lancet. Neurology. 5 (9): 780–790. doi:10.1016/S1474-4422(06)70547-6. PMID 16914406. Unknown parameter |month= ignored (help)

[15] Christine Klein & Laurie J. Ozelius (2002). "Dystonia: clinical features, genetics, and treatment". Current opinion in neurology. 15 (4): 491–497. PMID 12151848. Unknown parameter |month= ignored (help)

[pmid24326618-16] Chow E, Troy SB (2014). "The differential diagnosis of hypoglycorrhachia in adult patients". Am J Med Sci. 348 (3): 186–90. doi:10.1097/MAJ.0000000000000217. PMC 4065645. PMID 24326618.

[pmid22880096-17] Leen WG, Willemsen MA, Wevers RA, Verbeek MM (2012). "Cerebrospinal fluid glucose and lactate: age-specific reference values and implications for clinical practice". PLoS One. 7 (8): e42745. doi:10.1371/journal.pone.0042745. PMC 3412827. PMID 22880096.

[18] Charlotte Duverneuil, Geoffroy Lorin de la Grandmaison, Philippe de Mazancourt & Jean-Claude Alvarez (2004). "Liquid chromatography/photodiode array detection for determination of strychnine in blood: a fatal case report". Forensic science international. 141 (1): 17–21. doi:10.1016/j.forsciint.2003.12.010. PMID 15066709. Unknown parameter |month= ignored (help)

[19] B. A. Smith (1990). "Strychnine poisoning". The Journal of emergency medicine. 8 (3): 321–325. PMID 2197324. Unknown parameter |month= ignored (help)

[1]

[2]

[3]

[4]

[5]

[6]

[7]

[8]

[9]

[10]

[11]

[12]

[13]

[14]

[15]

[16]

[17]

[18]

[19]

@@ Line 320: / Line 320: @@
 * [[Benztropine]]
 |-
-| style="background: #F5F5F5; padding: 5px; text-align: center;" | [[Strychnine poisoning]]
+| style="background: #F5F5F5; padding: 5px; text-align: center;" | [[Strychnine poisoning]]<ref>{{Cite journal
+ | author = [[Charlotte Duverneuil]], [[Geoffroy Lorin de la Grandmaison]], [[Philippe de Mazancourt]] & [[Jean-Claude Alvarez]]
+ | title = Liquid chromatography/photodiode array detection for determination of strychnine in blood: a fatal case report
+ | journal = [[Forensic science international]]
+ | volume = 141
+ | issue = 1
+ | pages = 17–21
+ | year = 2004
+ | month = April
+ | doi = 10.1016/j.forsciint.2003.12.010
+ | pmid = 15066709
+}}</ref><ref>{{Cite journal
+ | author = [[B. A. Smith]]
+ | title = Strychnine poisoning
+ | journal = [[The Journal of emergency medicine]]
+ | volume = 8
+ | issue = 3
+ | pages = 321–325
+ | year = 1990
+ | month = May-June
+ | pmid = 2197324
+}}</ref>
 | style="background: #DCDCDC; padding: 5px;" |
 *Proper tetanus immunizations