Polio differential diagnosis: Difference between revisions

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__NOTOC__
__NOTOC__
{{Polio}}
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Polio]]
{{CMG}}; {{AE}} {{JS}}
{{CMG}}; {{AE}} {{JS}}
==Overview==
==Overview==
Abortive poliomyelitis must be differentiated from other diseases that cause: fever, nausea, vomiting, diarrhea, headache and sore throat, such as: gastroenteritis, or acute respiratory infection.<ref>{{cite journal |author=Falconer M, Bollenbach E |title=Late functional loss in nonparalytic polio |journal=American journal of physical medicine & rehabilitation / Association of Academic Physiatrists |volume=79 |issue=1 |pages=19–23 |year=2000 |pmid=10678598}}</ref><ref name="pmid2929811">{{cite journal| author=Sutter RW, Brink EW, Cochi SL, Kew OM, Orenstein WA, Biellik RJ et al.| title=A new epidemiologic and laboratory classification system for paralytic poliomyelitis cases. | journal=Am J Public Health | year= 1989 | volume= 79 | issue= 4 | pages= 495-8 | pmid=2929811 | doi= | pmc=PMC1349984 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2929811  }} </ref>
Abortive poliomyelitis must be differentiated from other diseases that cause  [[fever]], [[nausea]], [[vomiting]], [[diarrhea]], [[headache]], and [[sore throat]], such as [[gastroenteritis]] or acute [[respiratory infection]].<ref name="fal">{{cite journal |author=Falconer M, Bollenbach E |title=Late functional loss in nonparalytic polio |journal=American journal of physical medicine & rehabilitation / Association of Academic Physiatrists |volume=79 |issue=1 |pages=19–23 |year=2000 |pmid=10678598}}</ref><ref name="pmid2929811">{{cite journal| author=Sutter RW, Brink EW, Cochi SL, Kew OM, Orenstein WA, Biellik RJ et al.| title=A new epidemiologic and laboratory classification system for paralytic poliomyelitis cases. | journal=Am J Public Health | year= 1989 | volume= 79 | issue= 4 | pages= 495-8 | pmid=2929811 | doi= | pmc=PMC1349984 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2929811  }} </ref>


Non-paralytic poliomyelitis must be differentiated from other diseases that cause: [[fever]]; [[headache]]; [[myalgia]]; [[vomiting]]; [[lethargy]]; and [[muscle spasms]], such as:<ref name="pmid2929811">{{cite journal| author=Sutter RW, Brink EW, Cochi SL, Kew OM, Orenstein WA, Biellik RJ et al.| title=A new epidemiologic and laboratory classification system for paralytic poliomyelitis cases. | journal=Am J Public Health | year= 1989 | volume= 79 | issue= 4 | pages= 495-8 | pmid=2929811 | doi= | pmc=PMC1349984 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2929811  }} </ref><ref>{{cite journal |author=Falconer M, Bollenbach E |title=Late functional loss in nonparalytic polio |journal=American journal of physical medicine & rehabilitation / Association of Academic Physiatrists |volume=79 |issue=1 |pages=19–23 |year=2000 |pmid=10678598}}</ref>
Paralytic poliomyelitis must be differentiated from other diseases that cause [[headache]], [[muscle pain]], [[lethargy]], [[muscle weakness]], [[muscle spasms|spams]], and [[tremors]], such as [[Guillain-Barré syndrome]], traumatic [[neuritis]] of the [[sciatic nerve]]v [[transverse myelitis]]v and [[West Nile Virus]].<ref name="pmid2929811">{{cite journal| author=Sutter RW, Brink EW, Cochi SL, Kew OM, Orenstein WA, Biellik RJ et al.| title=A new epidemiologic and laboratory classification system for paralytic poliomyelitis cases. | journal=Am J Public Health | year= 1989 | volume= 79 | issue= 4 | pages= 495-8 | pmid=2929811 | doi= | pmc=PMC1349984 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2929811  }} </ref><ref name="fal">{{cite journal |author=Falconer M, Bollenbach E |title=Late functional loss in nonparalytic polio |journal=American journal of physical medicine & rehabilitation / Association of Academic Physiatrists |volume=79 |issue=1 |pages=19–23 |year=2000 |pmid=10678598}}</ref><ref name="pmid8442872">{{cite journal| author=Alcalá H| title=[The differential diagnosis of poliomyelitis and other acute flaccid paralyses]. | journal=Bol Med Hosp Infant Mex | year= 1993 | volume= 50 | issue= 2 | pages= 136-44 | pmid=8442872 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8442872  }} </ref><ref name="pmid10722421">{{cite journal| author=Asnis DS, Conetta R, Teixeira AA, Waldman G, Sampson BA| title=The West Nile Virus outbreak of 1999 in New York: the Flushing Hospital experience. | journal=Clin Infect Dis | year= 2000 | volume= 30 | issue= 3 | pages= 413-8 | pmid=10722421 | doi=10.1086/313737 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10722421  }} </ref><ref name="CampbellMarfin2002">{{cite journal|last1=Campbell|first1=Grant L|last2=Marfin|first2=Anthony A|last3=Lanciotti|first3=Robert S|last4=Gubler|first4=Duane J|title=West Nile virus|journal=The Lancet Infectious Diseases|volume=2|issue=9|year=2002|pages=519–529|issn=14733099|doi=10.1016/S1473-3099(02)00368-7}}</ref><ref name="pmid10079959">{{cite journal| author=Moorthi S, Schneider WN, Dombovy ML| title=Rehabilitation outcomes in encephalitis--a retrospective study 1990-1997. | journal=Brain Inj | year= 1999 | volume= 13 | issue= 2 | pages= 139-46 | pmid=10079959 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10079959  }} </ref>


Paralytic poliomyelitis must be differentiated from other diseases that cause: [[headache]], [[muscle pain]]; [[lethargy]], [[muscle weakness]], [[muscle spasms|spams]] and [[tremors]], such as: [[Guillain-Barré syndrome]]; traumatic [[neuritis]] of the [[sciatic nerve]]; [[transverse myelitis]]; and [[West Nile Virus]].<ref name="pmid2929811">{{cite journal| author=Sutter RW, Brink EW, Cochi SL, Kew OM, Orenstein WA, Biellik RJ et al.| title=A new epidemiologic and laboratory classification system for paralytic poliomyelitis cases. | journal=Am J Public Health | year= 1989 | volume= 79 | issue= 4 | pages= 495-8 | pmid=2929811 | doi= | pmc=PMC1349984 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2929811  }} </ref><ref>{{cite journal |author=Falconer M, Bollenbach E |title=Late functional loss in nonparalytic polio |journal=American journal of physical medicine & rehabilitation / Association of Academic Physiatrists |volume=79 |issue=1 |pages=19–23 |year=2000 |pmid=10678598}}</ref><ref name="pmid8442872">{{cite journal| author=Alcalá H| title=[The differential diagnosis of poliomyelitis and other acute flaccid paralyses]. | journal=Bol Med Hosp Infant Mex | year= 1993 | volume= 50 | issue= 2 | pages= 136-44 | pmid=8442872 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8442872  }} </ref><ref name="pmid10722421">{{cite journal| author=Asnis DS, Conetta R, Teixeira AA, Waldman G, Sampson BA| title=The West Nile Virus outbreak of 1999 in New York: the Flushing Hospital experience. | journal=Clin Infect Dis | year= 2000 | volume= 30 | issue= 3 | pages= 413-8 | pmid=10722421 | doi=10.1086/313737 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10722421  }} </ref><ref name="CampbellMarfin2002">{{cite journal|last1=Campbell|first1=Grant L|last2=Marfin|first2=Anthony A|last3=Lanciotti|first3=Robert S|last4=Gubler|first4=Duane J|title=West Nile virus|journal=The Lancet Infectious Diseases|volume=2|issue=9|year=2002|pages=519–529|issn=14733099|doi=10.1016/S1473-3099(02)00368-7}}</ref><ref name="pmid10079959">{{cite journal| author=Moorthi S, Schneider WN, Dombovy ML| title=Rehabilitation outcomes in encephalitis--a retrospective study 1990-1997. | journal=Brain Inj | year= 1999 | volume= 13 | issue= 2 | pages= 139-46 | pmid=10079959 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10079959  }} </ref>
==Differential Diagnosis==
The table below summarizes the findings that differentiate poliomyelitis from other conditions that cause [[headache]], [[fever]], [[muscle pain]]; [[nausea]] and [[vomiting]]:<ref name="pmid2929811">{{cite journal| author=Sutter RW, Brink EW, Cochi SL, Kew OM, Orenstein WA, Biellik RJ et al.| title=A new epidemiologic and laboratory classification system for paralytic poliomyelitis cases. | journal=Am J Public Health | year= 1989 | volume= 79 | issue= 4 | pages= 495-8 | pmid=2929811 | doi= | pmc=PMC1349984 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2929811  }} </ref><ref name="fal">{{cite journal |author=Falconer M, Bollenbach E |title=Late functional loss in nonparalytic polio |journal=American journal of physical medicine & rehabilitation / Association of Academic Physiatrists |volume=79 |issue=1 |pages=19–23 |year=2000 |pmid=10678598}}</ref><ref name="pmid8442872">{{cite journal| author=Alcalá H| title=[The differential diagnosis of poliomyelitis and other acute flaccid paralyses]. | journal=Bol Med Hosp Infant Mex | year= 1993 | volume= 50 | issue= 2 | pages= 136-44 | pmid=8442872 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8442872  }} </ref><ref name="pmid10722421">{{cite journal| author=Asnis DS, Conetta R, Teixeira AA, Waldman G, Sampson BA| title=The West Nile Virus outbreak of 1999 in New York: the Flushing Hospital experience. | journal=Clin Infect Dis | year= 2000 | volume= 30 | issue= 3 | pages= 413-8 | pmid=10722421 | doi=10.1086/313737 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10722421  }} </ref><ref name="CampbellMarfin2002">{{cite journal|last1=Campbell|first1=Grant L|last2=Marfin|first2=Anthony A|last3=Lanciotti|first3=Robert S|last4=Gubler|first4=Duane J|title=West Nile virus|journal=The Lancet Infectious Diseases|volume=2|issue=9|year=2002|pages=519–529|issn=14733099|doi=10.1016/S1473-3099(02)00368-7}}</ref><ref name="pmid10079959">{{cite journal| author=Moorthi S, Schneider WN, Dombovy ML| title=Rehabilitation outcomes in encephalitis--a retrospective study 1990-1997. | journal=Brain Inj | year= 1999 | volume= 13 | issue= 2 | pages= 139-46 | pmid=10079959 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10079959  }} </ref><ref name=PubMed>{{cite web | title = Poliomyelitis | url = http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0004457/ }}</ref>


==Differential Diagnosis==
===Abortive Poliomyelitis===
===Abortive Poliomyelitis===
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| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Gastroenteritis]]'''
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Gastroenteritis]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |  
| style="padding: 5px 5px; background: #F5F5F5;" | Self-limited condition that often presents with [[abdominal pain]], [[diarrhea]], [[fever]], [[loss of appetite]]; [[nausea]] and [[vomiting]].  It may be differentiated from abortive poliomyelitis with serologic tests.
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| style="padding: 5px 5px; background: #DCDCDC;" | '''Acute [[respiratory infection]]'''
| style="padding: 5px 5px; background: #DCDCDC;" | '''Acute [[respiratory infection]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |  
| style="padding: 5px 5px; background: #F5F5F5;" | Often presents with [[nasal discharge]] or [[nasal congestion|congestion]], [[sore throat]], [[cough]], [[fever]], [[headache]], [[malaise]], and [[muscle weakness]].  It may be differentiated from abortive poliomyelitis with [[serologic]] tests.
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===Non-Paralytic Poliomyelitis===
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===Paralytic Poliomyelitis===
===Paralytic Poliomyelitis===
The table below summarizes the findings that differentiate poliomyelitis from other conditions that cause [[headache]], [[muscle pain]]; [[lethargy]], [[muscle weakness]], [[muscle spasms|spams]] and [[tremors]]:<ref name="pmid2929811">{{cite journal| author=Sutter RW, Brink EW, Cochi SL, Kew OM, Orenstein WA, Biellik RJ et al.| title=A new epidemiologic and laboratory classification system for paralytic poliomyelitis cases. | journal=Am J Public Health | year= 1989 | volume= 79 | issue= 4 | pages= 495-8 | pmid=2929811 | doi= | pmc=PMC1349984 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2929811  }} </ref><ref>{{cite journal |author=Falconer M, Bollenbach E |title=Late functional loss in nonparalytic polio |journal=American journal of physical medicine & rehabilitation / Association of Academic Physiatrists |volume=79 |issue=1 |pages=19–23 |year=2000 |pmid=10678598}}</ref><ref name="pmid8442872">{{cite journal| author=Alcalá H| title=[The differential diagnosis of poliomyelitis and other acute flaccid paralyses]. | journal=Bol Med Hosp Infant Mex | year= 1993 | volume= 50 | issue= 2 | pages= 136-44 | pmid=8442872 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8442872  }} </ref><ref name="pmid10722421">{{cite journal| author=Asnis DS, Conetta R, Teixeira AA, Waldman G, Sampson BA| title=The West Nile Virus outbreak of 1999 in New York: the Flushing Hospital experience. | journal=Clin Infect Dis | year= 2000 | volume= 30 | issue= 3 | pages= 413-8 | pmid=10722421 | doi=10.1086/313737 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10722421  }} </ref><ref name="CampbellMarfin2002">{{cite journal|last1=Campbell|first1=Grant L|last2=Marfin|first2=Anthony A|last3=Lanciotti|first3=Robert S|last4=Gubler|first4=Duane J|title=West Nile virus|journal=The Lancet Infectious Diseases|volume=2|issue=9|year=2002|pages=519–529|issn=14733099|doi=10.1016/S1473-3099(02)00368-7}}</ref><ref name="pmid10079959">{{cite journal| author=Moorthi S, Schneider WN, Dombovy ML| title=Rehabilitation outcomes in encephalitis--a retrospective study 1990-1997. | journal=Brain Inj | year= 1999 | volume= 13 | issue= 2 | pages= 139-46 | pmid=10079959 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10079959  }} </ref>
The table below summarizes the findings that differentiate poliomyelitis from other conditions that cause [[headache]], [[muscle pain]]; [[lethargy]], [[muscle weakness]], [[muscle spasms|spams]] and [[tremors]]:<ref name="pmid2929811">{{cite journal| author=Sutter RW, Brink EW, Cochi SL, Kew OM, Orenstein WA, Biellik RJ et al.| title=A new epidemiologic and laboratory classification system for paralytic poliomyelitis cases. | journal=Am J Public Health | year= 1989 | volume= 79 | issue= 4 | pages= 495-8 | pmid=2929811 | doi= | pmc=PMC1349984 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2929811  }} </ref><ref name="fal">{{cite journal |author=Falconer M, Bollenbach E |title=Late functional loss in nonparalytic polio |journal=American journal of physical medicine & rehabilitation / Association of Academic Physiatrists |volume=79 |issue=1 |pages=19–23 |year=2000 |pmid=10678598}}</ref><ref name="pmid8442872">{{cite journal| author=Alcalá H| title=[The differential diagnosis of poliomyelitis and other acute flaccid paralyses]. | journal=Bol Med Hosp Infant Mex | year= 1993 | volume= 50 | issue= 2 | pages= 136-44 | pmid=8442872 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8442872  }} </ref><ref name="pmid10722421">{{cite journal| author=Asnis DS, Conetta R, Teixeira AA, Waldman G, Sampson BA| title=The West Nile Virus outbreak of 1999 in New York: the Flushing Hospital experience. | journal=Clin Infect Dis | year= 2000 | volume= 30 | issue= 3 | pages= 413-8 | pmid=10722421 | doi=10.1086/313737 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10722421  }} </ref><ref name="CampbellMarfin2002">{{cite journal|last1=Campbell|first1=Grant L|last2=Marfin|first2=Anthony A|last3=Lanciotti|first3=Robert S|last4=Gubler|first4=Duane J|title=West Nile virus|journal=The Lancet Infectious Diseases|volume=2|issue=9|year=2002|pages=519–529|issn=14733099|doi=10.1016/S1473-3099(02)00368-7}}</ref><ref name="pmid10079959">{{cite journal| author=Moorthi S, Schneider WN, Dombovy ML| title=Rehabilitation outcomes in encephalitis--a retrospective study 1990-1997. | journal=Brain Inj | year= 1999 | volume= 13 | issue= 2 | pages= 139-46 | pmid=10079959 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10079959  }} </ref><ref name=PubMed>{{cite web | title = Poliomyelitis | url = http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0004457/ }}</ref>


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| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Guillain-Barré syndrome]]'''
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Guillain-Barré syndrome]]'''
| style="padding: 5px 5px; background: #F5F5F5;" | Often presents with distal, ascending, symmetrical paralysis with abolished reflexes.  Unlike paralytic poliomyelitis, it does not cause muscular atrophy, or skeletal deformities.
| style="padding: 5px 5px; background: #F5F5F5;" | Often presents with distal, ascending, symmetrical [[paralysis]] with abolished [[reflexes]].  Unlike paralytic poliomyelitis, it does not cause muscular atrophy, or [[skeletal]] deformities.
|-
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| style="padding: 5px 5px; background: #DCDCDC;" | '''Traumatic [[neuritis]] of the [[sciatic nerve]]'''
| style="padding: 5px 5px; background: #DCDCDC;" | '''Traumatic [[neuritis]] of the [[sciatic nerve]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |  
| style="padding: 5px 5px; background: #F5F5F5;" | Often occurs few days after [[intramuscular]] injections, presenting with pain and decreased temperature of the affected limb.  Unlike paralytic poliomyelitis, it has an injection as causative agent, and does not cause [[muscular]] atrophy, or [[skeletal]] deformities.
|-
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| style="padding: 5px 5px; background: #DCDCDC;" |'''[[Transverse myelitis]]'''
| style="padding: 5px 5px; background: #DCDCDC;" |'''[[Transverse myelitis]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" | Often presents as symmetrical, flaccid [[paresis]], decreased sensory level and [[neurogenic bladder]].  Unlike [[paralytic]] poliomyelitis, it does not typically cause [[skeletal]] deformities.
|-
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| style="padding: 5px 5px; background: #DCDCDC;" |'''[[West Nile Virus]]'''
| style="padding: 5px 5px; background: #DCDCDC;" |'''[[West Nile Virus]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" | May present as a mild disease, with [[abdominal pain]], [[diarrhea]], [[fever]], [[headache]], and [[myalgia]], or as a more severe form, that may be life-threatening, called West Nile [[encephalitis]], which may present with: [[confusion]], [[muscle weakness]], and [[stiff neck]].  It may be differentiated from paralytic poliomyelitis with serologic tests.
 
|-
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| style="padding: 5px 5px; background: #DCDCDC;" |'''[[Encephalitis]]'''
| style="padding: 5px 5px; background: #DCDCDC;" |'''[[Encephalitis]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" | Often occurs with [[fever]]; [[confusion]]; [[irritability]]; [[vomiting]]; and [[stiff neck]].  Commonly, it does not present with [[paralysis]] and may be differentiated from paralytic poliomyelitis with [[serologic]] tests.
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<!--
 
TNC presents several days after IM injections with pain and hypothermia in the affected limbs; TM is a flaccid, symmetrical paraparesis with neurogenic bladder and a sensory level. CSF and neurophysiological studies (EMG and NCV) are very useful for diagnosis. Other entities misdiagnosed as poliomyelitis were: osteoarticular trauma, myopathies and dystrophies, viral myositis, acute cerebellitis, retroperitoneal tumors and upper motor neuron syndromes. Viral studies in stool specimens are essential for the diagnosis of poliomyelitis
The following table differentiates poliomyelitis from other diseases that cause [[muscle weakness]], [[hypotonia]], and [[flaccid paralysis]]:<ref name="pmid29433111">{{cite journal |vauthors=Kira R |title=[Acute Flaccid Myelitis] |language=Japanese |journal=Brain Nerve |volume=70 |issue=2 |pages=99–112 |date=February 2018 |pmid=29433111 |doi=10.11477/mf.1416200962 |url=}}</ref><ref name="pmid29433111">{{cite journal |vauthors=Kira R |title=[Acute Flaccid Myelitis] |language=Japanese |journal=Brain Nerve |volume=70 |issue=2 |pages=99–112 |date=February 2018 |pmid=29433111 |doi=10.11477/mf.1416200962 |url=}}</ref><ref name="pmid29181601">{{cite journal |vauthors=Hopkins SE |title=Acute Flaccid Myelitis: Etiologic Challenges, Diagnostic and Management Considerations |journal=Curr Treat Options Neurol |volume=19 |issue=12 |pages=48 |date=November 2017 |pmid=29181601 |doi=10.1007/s11940-017-0480-3 |url=}}</ref><ref name="pmid27422805">{{cite journal |vauthors=Messacar K, Schreiner TL, Van Haren K, Yang M, Glaser CA, Tyler KL, Dominguez SR |title=Acute flaccid myelitis: A clinical review of US cases 2012-2015 |journal=Ann. Neurol. |volume=80 |issue=3 |pages=326–38 |date=September 2016 |pmid=27422805 |pmc=5098271 |doi=10.1002/ana.24730 |url=}}</ref><ref name="pmid29028962">{{cite journal |vauthors=Chong PF, Kira R, Mori H, Okumura A, Torisu H, Yasumoto S, Shimizu H, Fujimoto T, Hanaoka N, Kusunoki S, Takahashi T, Oishi K, Tanaka-Taya K |title=Clinical Features of Acute Flaccid Myelitis Temporally Associated With an Enterovirus D68 Outbreak: Results of a Nationwide Survey of Acute Flaccid Paralysis in Japan, August-December 2015 |journal=Clin. Infect. Dis. |volume=66 |issue=5 |pages=653–664 |date=February 2018 |pmid=29028962 |pmc=5850449 |doi=10.1093/cid/cix860 |url=}}</ref><ref name="pmid29482893">{{cite journal |vauthors=Messacar K, Asturias EJ, Hixon AM, Van Leer-Buter C, Niesters HGM, Tyler KL, Abzug MJ, Dominguez SR |title=Enterovirus D68 and acute flaccid myelitis-evaluating the evidence for causality |journal=Lancet Infect Dis |volume=18 |issue=8 |pages=e239–e247 |date=August 2018 |pmid=29482893 |doi=10.1016/S1473-3099(18)30094-X |url=}}</ref><ref name="pmid30200066">{{cite journal |vauthors=Chen IJ, Hu SC, Hung KL, Lo CW |title=Acute flaccid myelitis associated with enterovirus D68 infection: A case report |journal=Medicine (Baltimore) |volume=97 |issue=36 |pages=e11831 |date=September 2018 |pmid=30200066 |pmc=6133480 |doi=10.1097/MD.0000000000011831 |url=}}</ref><ref name="urlBotulism | Botulism | CDC">{{cite web |url=https://www.cdc.gov/botulism/index.html |title=Botulism &#124; Botulism &#124; CDC |format= |work= |accessdate=}}</ref><ref name="pmid3290234">{{cite journal |vauthors=McCroskey LM, Hatheway CL |title=Laboratory findings in four cases of adult botulism suggest colonization of the intestinal tract |journal=J. Clin. Microbiol. |volume=26 |issue=5 |pages=1052–4 |date=May 1988 |pmid=3290234 |pmc=266519 |doi= |url=}}</ref><ref name="pmid16614251">{{cite journal |vauthors=Lindström M, Korkeala H |title=Laboratory diagnostics of botulism |journal=Clin. Microbiol. Rev. |volume=19 |issue=2 |pages=298–314 |date=April 2006 |pmid=16614251 |pmc=1471988 |doi=10.1128/CMR.19.2.298-314.2006 |url=}}</ref><ref name="pmid17224901">{{cite journal |vauthors=Brook I |title=Botulism: the challenge of diagnosis and treatment |journal=Rev Neurol Dis |volume=3 |issue=4 |pages=182–9 |date=2006 |pmid=17224901 |doi= |url=}}</ref><ref name="pmid23642721">{{cite journal |vauthors=Dimachkie MM, Barohn RJ |title=Guillain-Barré syndrome and variants |journal=Neurol Clin |volume=31 |issue=2 |pages=491–510 |date=May 2013 |pmid=23642721 |pmc=3939842 |doi=10.1016/j.ncl.2013.01.005 |url=}}</ref><ref name="pmid23418763">{{cite journal |vauthors=Walling AD, Dickson G |title=Guillain-Barré syndrome |journal=Am Fam Physician |volume=87 |issue=3 |pages=191–7 |date=February 2013 |pmid=23418763 |doi= |url=}}</ref><ref name="pmid21969911">{{cite journal |vauthors=Gilhus NE |title=Lambert-eaton myasthenic syndrome; pathogenesis, diagnosis, and therapy |journal=Autoimmune Dis |volume=2011 |issue= |pages=973808 |date=2011 |pmid=21969911 |pmc=3182560 |doi=10.4061/2011/973808 |url=}}</ref><ref name="pmid14977560">{{cite journal |vauthors=Krishnan C, Kaplin AI, Deshpande DM, Pardo CA, Kerr DA |title=Transverse Myelitis: pathogenesis, diagnosis and treatment |journal=Front. Biosci. |volume=9 |issue= |pages=1483–99 |date=May 2004 |pmid=14977560 |doi= |url=}}</ref><ref name="pmid24305450">{{cite journal |vauthors=Amato AA, Greenberg SA |title=Inflammatory myopathies |journal=Continuum (Minneap Minn) |volume=19 |issue=6 Muscle Disease |pages=1615–33 |date=December 2013 |pmid=24305450 |doi=10.1212/01.CON.0000440662.26427.bd |url=}}</ref><ref name="pmid24365430">{{cite journal |vauthors=Berger JR, Dean D |title=Neurosyphilis |journal=Handb Clin Neurol |volume=121 |issue= |pages=1461–72 |date=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="8" |<small>History and Physical
! colspan="2" |<small>Diagnostic tests</small>
! rowspan="2" |<small>Other Findings</small>
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
!<small>Motor Deficit</small>
!<small>Sensory deficit</small>
!<small>Cranial nerve Involvement</small>
!<small>Autonomic dysfunction</small>
!<small>Proximal/Distal/Generalized</small>
!<small>Ascending/Descending/Systemic</small>
!<small>Unilateral (UL)
or Bilateral (BL)
 
or
 
No Lateralization (NL)</small>
!<small>Onset</small>
!<small>Lab or Imaging Findings</small>
!<small>Specific  test</small>
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" | Adult Botulism
| 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" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px; text-align:center" |Generalized
| style="background: #F5F5F5; padding: 5px; text-align:center" |Descending
| style="background: #F5F5F5; padding: 5px; text-align:center" |BL
| style="background: #F5F5F5; padding: 5px; text-align:center" |Sudden
| style="background: #F5F5F5; padding: 5px; text-align:center" |Toxin test
| style="background: #F5F5F5; padding: 5px; text-align:center" |Blood, Wound, or Stool culture
| style="background: #F5F5F5; padding: 5px; text-align:center" |[[Diplopia]], [[Hyporeflexia|Hyporeflexia,]] [[Hypotonia]], possible respiratory paralysis
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Infant Botulism
| 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" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px; text-align:center" |Generalized
| style="background: #F5F5F5; padding: 5px; text-align:center" |Descending
| style="background: #F5F5F5; padding: 5px; text-align:center" |BL
| style="background: #F5F5F5; padding: 5px; text-align:center" |Sudden
| style="background: #F5F5F5; padding: 5px; text-align:center" |Toxin test
| style="background: #F5F5F5; padding: 5px; text-align:center" |Blood, Wound, or Stool culture
| style="background: #F5F5F5; padding: 5px; text-align:center" |[[Flaccid paralysis]] ([[Floppy baby syndrome]]), possible respiratory paralysis
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" | [[Guillian-Barre syndrome]]<ref name="pmid22081202">{{cite journal| author=Talukder RK, Sutradhar SR, Rahman KM, Uddin MJ, Akhter H| title=Guillian-Barre syndrome. | journal=Mymensingh Med J | year= 2011 | volume= 20 | issue= 4 | pages= 748-56 | pmid=22081202 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22081202  }}</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" |<nowiki>-</nowiki>
| style="background: #F5F5F5; padding: 5px; text-align:center" |Generalized
| style="background: #F5F5F5; padding: 5px; text-align:center" |Ascending
| style="background: #F5F5F5; padding: 5px; text-align:center" |BL
| style="background: #F5F5F5; padding: 5px; text-align:center" |Insidious
| style="background: #F5F5F5; padding: 5px; text-align:center" |CSF: ↑Protein
 
↓Cells
 
| style="background: #F5F5F5; padding: 5px; text-align:center" |Clinical & Lumbar Puncture
| style="background: #F5F5F5; padding: 5px; text-align:center" |Progressive [[ascending paralysis]] following infection, possible respiratory paralysis
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" | [[Eaton lambert syndrome|Eaton Lambert syndrome]]<ref name="pmid27412406">{{cite journal| author=Merino-Ramírez MÁ, Bolton CF| title=Review of the Diagnostic Challenges of Lambert-Eaton Syndrome Revealed Through Three Case Reports. | journal=Can J Neurol Sci | year= 2016 | volume= 43 | issue= 5 | pages= 635-47 | pmid=27412406 | doi=10.1017/cjn.2016.268 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27412406  }}</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" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px; text-align:center" |Generalized
| style="background: #F5F5F5; padding: 5px; text-align:center" |Systemic
| style="background: #F5F5F5; padding: 5px; text-align:center" |BL
| style="background: #F5F5F5; padding: 5px; text-align:center" |Intermittent
| style="background: #F5F5F5; padding: 5px; text-align:center" | [[EMG]], repetitive nerve stimulation test (RNS)
| style="background: #F5F5F5; padding: 5px; text-align:center" |[[Voltage gated calcium channel|Voltage gated calcium channe]]<nowiki/>l<nowiki/> (VGCC) antibody
| style="background: #F5F5F5; padding: 5px; text-align:center" |[[Diplopia]], [[ptosis]], improves with movement (as the day progresses)
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Myasthenia gravis]]<ref name="pmid28029925">{{cite journal| author=Gilhus NE| title=Myasthenia Gravis. | journal=N Engl J Med | year= 2016 | volume= 375 | issue= 26 | pages= 2570-2581 | pmid=28029925 | doi=10.1056/NEJMra1602678 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28029925  }}</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" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px; text-align:center" |Generalized
| style="background: #F5F5F5; padding: 5px; text-align:center" |Systemic
| style="background: #F5F5F5; padding: 5px; text-align:center" |BL
| style="background: #F5F5F5; padding: 5px; text-align:center" |Intermittent
| style="background: #F5F5F5; padding: 5px; text-align:center" | [[Electromyography|EMG]], [[Edrophonium|Edrophonium test]]
| style="background: #F5F5F5; padding: 5px; text-align:center" |[[Acetylcholine receptor|Ach receptor]] antibody
| style="background: #F5F5F5; padding: 5px; text-align:center" |[[Diplopia]], [[ptosis]], worsening with movement (as the day progresses)
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Electrolyte disturbance]]<ref name="pmid26813501">{{cite journal| author=Ozono K| title=[Diagnostic criteria for vitamin D-deficient rickets and hypocalcemia-]. | journal=Clin Calcium | year= 2016 | volume= 26 | issue= 2 | pages= 215-22 | pmid=26813501 | doi=CliCa1602215222 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26813501  }}</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" |<nowiki>-</nowiki>
| style="background: #F5F5F5; padding: 5px; text-align:center" |Generalized
| style="background: #F5F5F5; padding: 5px; text-align:center" |Systemic
| style="background: #F5F5F5; padding: 5px; text-align:center" |BL
| style="background: #F5F5F5; padding: 5px; text-align:center" |Insidious
| style="background: #F5F5F5; padding: 5px; text-align:center" | Electrolyte panel
| style="background: #F5F5F5; padding: 5px; text-align:center" |↓Ca++, ↓Mg++, ↓K+
| style="background: #F5F5F5; padding: 5px; text-align:center" |Possible [[arrhythmia]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Organophosphate poisoning|Organophosphate toxicity]]<ref name="pmid15020723">{{cite journal| author=Kamanyire R, Karalliedde L| title=Organophosphate toxicity and occupational exposure. | journal=Occup Med (Lond) | year= 2004 | volume= 54 | issue= 2 | pages= 69-75 | pmid=15020723 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15020723  }}</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" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px; text-align:center" |Generalized
| style="background: #F5F5F5; padding: 5px; text-align:center" |Ascending
| style="background: #F5F5F5; padding: 5px; text-align:center" |BL
| style="background: #F5F5F5; padding: 5px; text-align:center" |Sudden
| style="background: #F5F5F5; padding: 5px; text-align:center" | Clinical diagnosis: physical exam & history
| style="background: #F5F5F5; padding: 5px; text-align:center" |Clinical suspicion confirmed with RBC AchE activity
| style="background: #F5F5F5; padding: 5px; text-align:center" |History of exposure to i[[Insecticide|nsecticide]] or living in farming environment. with : [[Diarrhea]], [[Urination]], [[Miosis]], [[Bradycardia]], [[Lacrimation]], [[Emesis]], [[Salivation]], [[Sweating]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Tick paralysis]] ([[Dermacentor andersoni|Dermacentor tick]])<ref name="pmid23677663">{{cite journal| author=Pecina CA| title=Tick paralysis. | journal=Semin Neurol | year= 2012 | volume= 32 | issue= 5 | pages= 531-2 | pmid=23677663 | doi=10.1055/s-0033-1334474 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23677663  }}</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" |<nowiki>-</nowiki>
| style="background: #F5F5F5; padding: 5px; text-align:center" |Generalized
| style="background: #F5F5F5; padding: 5px; text-align:center" |Ascending
| style="background: #F5F5F5; padding: 5px; text-align:center" |BL
| style="background: #F5F5F5; padding: 5px; text-align:center" |Insidious
| style="background: #F5F5F5; padding: 5px; text-align:center" | Clinical diagnosis: physical exam & history
| style="background: #F5F5F5; padding: 5px; text-align:center" |-
| style="background: #F5F5F5; padding: 5px; text-align:center" |History of outdoor activity in Northeastern United States. The tick is often still latched to the patient at presentation (often in head and neck area)
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Tetrodotoxin]] poisoning<ref name="pmid24566728">{{cite journal| author=Bane V, Lehane M, Dikshit M, O'Riordan A, Furey A| title=Tetrodotoxin: chemistry, toxicity, source, distribution and detection. | journal=Toxins (Basel) | year= 2014 | volume= 6 | issue= 2 | pages= 693-755 | pmid=24566728 | doi=10.3390/toxins6020693 | pmc=3942760 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24566728  }}</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" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px; text-align:center" |Generalized
| style="background: #F5F5F5; padding: 5px; text-align:center" |Systemic
| style="background: #F5F5F5; padding: 5px; text-align:center" |BL
| style="background: #F5F5F5; padding: 5px; text-align:center" |Sudden
| style="background: #F5F5F5; padding: 5px; text-align:center" | Clinical diagnosis: physical exam & dietary history
| style="background: #F5F5F5; padding: 5px; text-align:center" | -
| style="background: #F5F5F5; padding: 5px; text-align:center" | History of consumption of puffer fish species.
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Stroke]]<ref name="pmid8848683">{{cite journal| author=Kuntzer T, Hirt L, Bogousslavsky J| title=[Neuromuscular involvement and cerebrovascular accidents]. | journal=Rev Med Suisse Romande | year= 1996 | volume= 116 | issue= 8 | pages= 605-9 | pmid=8848683 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8848683  }}</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" |<nowiki>+/-</nowiki>
| style="background: #F5F5F5; padding: 5px; text-align:center" |Generalized
| style="background: #F5F5F5; padding: 5px; text-align:center" |Systemic
| style="background: #F5F5F5; padding: 5px; text-align:center" |UL
| style="background: #F5F5F5; padding: 5px; text-align:center" |Sudden
| style="background: #F5F5F5; padding: 5px; text-align:center" | MRI +ve for ischemia or hemorrhage
| style="background: #F5F5F5; padding: 5px; text-align:center" |MRI
| style="background: #F5F5F5; padding: 5px; text-align:center" |Sudden unilateral motor and sensory deficit in a patient with a history of [[Atherosclerosis|atherosclero]]<nowiki/>tic risk factors (diabetes, hypertension, smoking) or [[Atrial fibrillation|atrial fibrillation.]]
|-
| style="background: #DCDCDC; padding: 5px; text-align:center;" | [[Poliomyelitis]]<ref name="pmid19944665">{{cite journal| author=Laffont I, Julia M, Tiffreau V, Yelnik A, Herisson C, Pelissier J| title=Aging and sequelae of poliomyelitis. | journal=Ann Phys Rehabil Med | year= 2010 | volume= 53 | issue= 1 | pages= 24-33 | pmid=19944665 | doi=10.1016/j.rehab.2009.10.002 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19944665  }}</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" |Proximal > Distal
| style="background: #F5F5F5; padding: 5px; text-align:center" |Systemic
| style="background: #F5F5F5; padding: 5px; text-align:center" |BL or UL
| style="background: #F5F5F5; padding: 5px; text-align:center" |Sudden
| style="background: #F5F5F5; padding: 5px; text-align:center" |
| style="background: #F5F5F5; padding: 5px; text-align:center" |PCR of CSF
| style="background: #F5F5F5; padding: 5px; text-align:center" |Asymmetric paralysis following a flu-like syndrome.
|-
| style="background: #DCDCDC; padding: 5px; text-align:center;" | [[Transverse myelitis]]<ref name="pmid24099672">{{cite journal| author=West TW| title=Transverse myelitis--a review of the presentation, diagnosis, and initial management. | journal=Discov Med | year= 2013 | volume= 16 | issue= 88 | pages= 167-77 | pmid=24099672 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24099672  }}</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" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px; text-align:center" |Proximal > Distal
| style="background: #F5F5F5; padding: 5px; text-align:center" |Systemic
| style="background: #F5F5F5; padding: 5px; text-align:center" |BL or UL
| style="background: #F5F5F5; padding: 5px; text-align:center" |Sudden
| style="background: #F5F5F5; padding: 5px; text-align:center" |MRI & [[Lumbar puncture]]
| style="background: #F5F5F5; padding: 5px; text-align:center" |MRI
| style="background: #F5F5F5; padding: 5px; text-align:center" |History of chronic viral or autoimmune disease (e.g. [[HIV]])
|-
| 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" |Generalized
| style="background: #F5F5F5; padding: 5px; text-align:center" |Systemic
| style="background: #F5F5F5; padding: 5px; text-align:center" |BL
| style="background: #F5F5F5; padding: 5px; text-align:center" |Insidious<nowiki/>
| style="background: #F5F5F5; padding: 5px; text-align:center" |MRI & [[Lumbar puncture]]
| style="background: #F5F5F5; padding: 5px; text-align:center" |CSF [[VDRL]]-specifc
CSF [[FTA-ABS|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" |History of unprotected sex or multiple sexual partners.
 
History of [[genital ulcer]] ([[chancre]]), diffuse [[Maculopapular rash|maculopapular ras]]<nowiki/>h.
|-
| style="background: #DCDCDC; padding: 5px; text-align:center;" |[[Muscular dystrophy]]<ref name="pmid26457695">{{cite journal| author=Falzarano MS, Scotton C, Passarelli C, Ferlini A| title=Duchenne Muscular Dystrophy: From Diagnosis to Therapy. | journal=Molecules | year= 2015 | volume= 20 | issue= 10 | pages= 18168-84 | pmid=26457695 | doi=10.3390/molecules201018168 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26457695  }}</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" |<nowiki>-</nowiki>
| style="background: #F5F5F5; padding: 5px; text-align:center" |Proximal > Distal
| style="background: #F5F5F5; padding: 5px; text-align:center" |Systemic
| style="background: #F5F5F5; padding: 5px; text-align:center" |BL
| style="background: #F5F5F5; padding: 5px; text-align:center" |Insidious
| style="background: #F5F5F5; padding: 5px; text-align:center" | Genetic testing
| style="background: #F5F5F5; padding: 5px; text-align:center" |[[Muscle biopsy]]
| style="background: #F5F5F5; padding: 5px; text-align:center" |Progressive proximal lower limb weakness with calf pseudohypertrophy in early childhood. [[Gowers' sign|Gower sign]] positive.
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Multiple sclerosis]] exacerbation<ref name="pmid27432676">{{cite journal| author=Filippi M, Preziosa P, Rocca MA| title=Multiple sclerosis. | journal=Handb Clin Neurol | year= 2016 | volume= 135 | issue=  | pages= 399-423 | pmid=27432676 | doi=10.1016/B978-0-444-53485-9.00020-9 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27432676  }}</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" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px; text-align:center" |Generalized
| style="background: #F5F5F5; padding: 5px; text-align:center" |Systemic
| style="background: #F5F5F5; padding: 5px; text-align:center" |NL
| style="background: #F5F5F5; padding: 5px; text-align:center" |Sudden
| style="background: #F5F5F5; padding: 5px; text-align:center" |'''[[CSF|↑]]'''[[CSF]] [[IgG]] levels
(monoclonal)
| style="background: #F5F5F5; padding: 5px; text-align:center" |Clinical assessment 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; text-align:center" |[[Blurred vision|Blurry vision]], [[urinary incontinence]], [[fatigue]]
|-
| style="background: #DCDCDC; padding: 5px; text-align:center" |[[Amyotrophic lateral sclerosis]]<ref name="pmid27025851">{{cite journal| author=Riva N, Agosta F, Lunetta C, Filippi M, Quattrini A| title=Recent advances in amyotrophic lateral sclerosis. | journal=J Neurol | year= 2016 | volume= 263 | issue= 6 | pages= 1241-54 | pmid=27025851 | doi=10.1007/s00415-016-8091-6 | pmc=4893385 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27025851  }}</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" |<nowiki>-</nowiki>
| style="background: #F5F5F5; padding: 5px; text-align:center" |Generalized
| style="background: #F5F5F5; padding: 5px; text-align:center" |Systemic
| style="background: #F5F5F5; padding: 5px; text-align:center" |BL
| style="background: #F5F5F5; padding: 5px; text-align:center" |Insidious
| style="background: #F5F5F5; padding: 5px; text-align:center" | Normal [[Lumbar puncture|LP]] (to rule out DDx)
| style="background: #F5F5F5; padding: 5px; text-align:center" |MRI & [[Lumbar puncture|LP]]
| style="background: #F5F5F5; padding: 5px; text-align:center" |Patient initially presents with [[upper motor neuron]] deficit ([[spasticity]]) followed by [[lower motor neuron]] deficit ([[flaccidity]]).
|-
| style="background: #DCDCDC; padding: 5px; text-align:center;" | [[Myositis|Inflammatory myopathy]]<ref name="pmid26290112">{{cite journal| author=Michelle EH, Mammen AL| title=Myositis Mimics. | journal=Curr Rheumatol Rep | year= 2015 | volume= 17 | issue= 10 | pages= 63 | pmid=26290112 | doi=10.1007/s11926-015-0541-0 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26290112  }}</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" |<nowiki>-</nowiki>
| style="background: #F5F5F5; padding: 5px; text-align:center" |Proximal > Distal
| style="background: #F5F5F5; padding: 5px; text-align:center" |Systemic
| style="background: #F5F5F5; padding: 5px; text-align:center" |UL or BL
| style="background: #F5F5F5; padding: 5px; text-align:center" |Insidious
| style="background: #F5F5F5; padding: 5px; text-align:center" |Elevated [[Creatine kinase|CK]] & [[Aldolase]]
| style="background: #F5F5F5; padding: 5px; text-align:center" |[[Muscle biopsy]]
| style="background: #F5F5F5; padding: 5px; text-align:center" |Progressive proximal muscle weakness in 3rd to 5th decade of life. With or without skin manifestations.
|-
|}


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
[[Category:Primary care]]
[[Category:Disease]]
[[Category:Infectious disease]]
{{WH}}
{{WH}}
{{WS}}
{{WS}}
[[Category:Disease]]

Latest revision as of 23:46, 29 July 2020

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

Overview

Abortive poliomyelitis must be differentiated from other diseases that cause fever, nausea, vomiting, diarrhea, headache, and sore throat, such as gastroenteritis or acute respiratory infection.[1][2]

Paralytic poliomyelitis must be differentiated from other diseases that cause headache, muscle pain, lethargy, muscle weakness, spams, and tremors, such as Guillain-Barré syndrome, traumatic neuritis of the sciatic nervev transverse myelitisv and West Nile Virus.[2][1][3][4][5][6]

Differential Diagnosis

The table below summarizes the findings that differentiate poliomyelitis from other conditions that cause headache, fever, muscle pain; nausea and vomiting:[2][1][3][4][5][6][7]

Abortive Poliomyelitis

Disease Findings
Gastroenteritis Self-limited condition that often presents with abdominal pain, diarrhea, fever, loss of appetite; nausea and vomiting. It may be differentiated from abortive poliomyelitis with serologic tests.
Acute respiratory infection Often presents with nasal discharge or congestion, sore throat, cough, fever, headache, malaise, and muscle weakness. It may be differentiated from abortive poliomyelitis with serologic tests.

Paralytic Poliomyelitis

The table below summarizes the findings that differentiate poliomyelitis from other conditions that cause headache, muscle pain; lethargy, muscle weakness, spams and tremors:[2][1][3][4][5][6][7]

Disease Findings
Guillain-Barré syndrome Often presents with distal, ascending, symmetrical paralysis with abolished reflexes. Unlike paralytic poliomyelitis, it does not cause muscular atrophy, or skeletal deformities.
Traumatic neuritis of the sciatic nerve Often occurs few days after intramuscular injections, presenting with pain and decreased temperature of the affected limb. Unlike paralytic poliomyelitis, it has an injection as causative agent, and does not cause muscular atrophy, or skeletal deformities.
Transverse myelitis Often presents as symmetrical, flaccid paresis, decreased sensory level and neurogenic bladder. Unlike paralytic poliomyelitis, it does not typically cause skeletal deformities.
West Nile Virus May present as a mild disease, with abdominal pain, diarrhea, fever, headache, and myalgia, or as a more severe form, that may be life-threatening, called West Nile encephalitis, which may present with: confusion, muscle weakness, and stiff neck. It may be differentiated from paralytic poliomyelitis with serologic tests.
Encephalitis Often occurs with fever; confusion; irritability; vomiting; and stiff neck. Commonly, it does not present with paralysis and may be differentiated from paralytic poliomyelitis with serologic tests.


The following table differentiates poliomyelitis from other diseases that cause muscle weakness, hypotonia, and flaccid paralysis:[8][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23]

Diseases History and Physical Diagnostic tests Other Findings
Motor Deficit Sensory deficit Cranial nerve Involvement Autonomic dysfunction Proximal/Distal/Generalized Ascending/Descending/Systemic Unilateral (UL)

or Bilateral (BL)

or

No Lateralization (NL)

Onset Lab or Imaging Findings Specific test
Adult Botulism + - + + Generalized Descending BL Sudden Toxin test Blood, Wound, or Stool culture Diplopia, Hyporeflexia, Hypotonia, possible respiratory paralysis
Infant Botulism + - + + Generalized Descending BL Sudden Toxin test Blood, Wound, or Stool culture Flaccid paralysis (Floppy baby syndrome), possible respiratory paralysis
Guillian-Barre syndrome[24] + - - - Generalized Ascending BL Insidious CSF: ↑Protein

↓Cells

Clinical & Lumbar Puncture Progressive ascending paralysis following infection, possible respiratory paralysis
Eaton Lambert syndrome[25] + - + + Generalized Systemic BL Intermittent EMG, repetitive nerve stimulation test (RNS) Voltage gated calcium channel (VGCC) antibody Diplopia, ptosis, improves with movement (as the day progresses)
Myasthenia gravis[26] + - + + Generalized Systemic BL Intermittent EMG, Edrophonium test Ach receptor antibody Diplopia, ptosis, worsening with movement (as the day progresses)
Electrolyte disturbance[27] + + - - Generalized Systemic BL Insidious Electrolyte panel ↓Ca++, ↓Mg++, ↓K+ Possible arrhythmia
Organophosphate toxicity[28] + + - + Generalized Ascending BL Sudden Clinical diagnosis: physical exam & history Clinical suspicion confirmed with RBC AchE activity History of exposure to insecticide or living in farming environment. with : Diarrhea, Urination, Miosis, Bradycardia, Lacrimation, Emesis, Salivation, Sweating
Tick paralysis (Dermacentor tick)[29] + - - - Generalized Ascending BL Insidious Clinical diagnosis: physical exam & history - History of outdoor activity in Northeastern United States. The tick is often still latched to the patient at presentation (often in head and neck area)
Tetrodotoxin poisoning[30] + - + + Generalized Systemic BL Sudden Clinical diagnosis: physical exam & dietary history - History of consumption of puffer fish species.
Stroke[31] +/- +/- +/- +/- Generalized Systemic UL Sudden MRI +ve for ischemia or hemorrhage MRI Sudden unilateral motor and sensory deficit in a patient with a history of atherosclerotic risk factors (diabetes, hypertension, smoking) or atrial fibrillation.
Poliomyelitis[32] + + + +/- Proximal > Distal Systemic BL or UL Sudden PCR of CSF Asymmetric paralysis following a flu-like syndrome.
Transverse myelitis[33] + + + + Proximal > Distal Systemic BL or UL Sudden MRI & Lumbar puncture MRI History of chronic viral or autoimmune disease (e.g. HIV)
Neurosyphilis[34][23] + + - +/- Generalized Systemic BL Insidious MRI & Lumbar puncture CSF VDRL-specifc

CSF FTA-Ab -sensitive[35]

History of unprotected sex or multiple sexual partners.

History of genital ulcer (chancre), diffuse maculopapular rash.

Muscular dystrophy[36] + - - - Proximal > Distal Systemic BL Insidious Genetic testing Muscle biopsy Progressive proximal lower limb weakness with calf pseudohypertrophy in early childhood. Gower sign positive.
Multiple sclerosis exacerbation[37] + + + + Generalized Systemic NL Sudden ↑CSF IgG levels

(monoclonal)

Clinical assessment and MRI [38] Blurry vision, urinary incontinence, fatigue
Amyotrophic lateral sclerosis[39] + - - - Generalized Systemic BL Insidious Normal LP (to rule out DDx) MRI & LP Patient initially presents with upper motor neuron deficit (spasticity) followed by lower motor neuron deficit (flaccidity).
Inflammatory myopathy[40] + - - - Proximal > Distal Systemic UL or BL Insidious Elevated CK & Aldolase Muscle biopsy Progressive proximal muscle weakness in 3rd to 5th decade of life. With or without skin manifestations.

References

  1. ↑ 1.0 1.1 1.2 1.3 Falconer M, Bollenbach E (2000). "Late functional loss in nonparalytic polio". American journal of physical medicine & rehabilitation / Association of Academic Physiatrists. 79 (1): 19–23. PMID 10678598.
  2. ↑ 2.0 2.1 2.2 2.3 Sutter RW, Brink EW, Cochi SL, Kew OM, Orenstein WA, Biellik RJ; et al. (1989). "A new epidemiologic and laboratory classification system for paralytic poliomyelitis cases". Am J Public Health. 79 (4): 495–8. PMC 1349984. PMID 2929811.
  3. ↑ 3.0 3.1 3.2 Alcalá H (1993). "[The differential diagnosis of poliomyelitis and other acute flaccid paralyses]". Bol Med Hosp Infant Mex. 50 (2): 136–44. PMID 8442872.
  4. ↑ 4.0 4.1 4.2 Asnis DS, Conetta R, Teixeira AA, Waldman G, Sampson BA (2000). "The West Nile Virus outbreak of 1999 in New York: the Flushing Hospital experience". Clin Infect Dis. 30 (3): 413–8. doi:10.1086/313737. PMID 10722421.
  5. ↑ 5.0 5.1 5.2 Campbell, Grant L; Marfin, Anthony A; Lanciotti, Robert S; Gubler, Duane J (2002). "West Nile virus". The Lancet Infectious Diseases. 2 (9): 519–529. doi:10.1016/S1473-3099(02)00368-7. ISSN 1473-3099.
  6. ↑ 6.0 6.1 6.2 Moorthi S, Schneider WN, Dombovy ML (1999). "Rehabilitation outcomes in encephalitis--a retrospective study 1990-1997". Brain Inj. 13 (2): 139–46. PMID 10079959.
  7. ↑ 7.0 7.1 "Poliomyelitis".
  8. ↑ 8.0 8.1 Kira R (February 2018). "[Acute Flaccid Myelitis]". Brain Nerve (in Japanese). 70 (2): 99–112. doi:10.11477/mf.1416200962. PMID 29433111.
  9. ↑ Hopkins SE (November 2017). "Acute Flaccid Myelitis: Etiologic Challenges, Diagnostic and Management Considerations". Curr Treat Options Neurol. 19 (12): 48. doi:10.1007/s11940-017-0480-3. PMID 29181601.
  10. ↑ Messacar K, Schreiner TL, Van Haren K, Yang M, Glaser CA, Tyler KL, Dominguez SR (September 2016). "Acute flaccid myelitis: A clinical review of US cases 2012-2015". Ann. Neurol. 80 (3): 326–38. doi:10.1002/ana.24730. PMC 5098271. PMID 27422805.
  11. ↑ Chong PF, Kira R, Mori H, Okumura A, Torisu H, Yasumoto S, Shimizu H, Fujimoto T, Hanaoka N, Kusunoki S, Takahashi T, Oishi K, Tanaka-Taya K (February 2018). "Clinical Features of Acute Flaccid Myelitis Temporally Associated With an Enterovirus D68 Outbreak: Results of a Nationwide Survey of Acute Flaccid Paralysis in Japan, August-December 2015". Clin. Infect. Dis. 66 (5): 653–664. doi:10.1093/cid/cix860. PMC 5850449. PMID 29028962.
  12. ↑ Messacar K, Asturias EJ, Hixon AM, Van Leer-Buter C, Niesters H, Tyler KL, Abzug MJ, Dominguez SR (August 2018). "Enterovirus D68 and acute flaccid myelitis-evaluating the evidence for causality". Lancet Infect Dis. 18 (8): e239–e247. doi:10.1016/S1473-3099(18)30094-X. PMID 29482893. Vancouver style error: initials (help)
  13. ↑ Chen IJ, Hu SC, Hung KL, Lo CW (September 2018). "Acute flaccid myelitis associated with enterovirus D68 infection: A case report". Medicine (Baltimore). 97 (36): e11831. doi:10.1097/MD.0000000000011831. PMC 6133480. PMID 30200066.
  14. ↑ "Botulism | Botulism | CDC".
  15. ↑ McCroskey LM, Hatheway CL (May 1988). "Laboratory findings in four cases of adult botulism suggest colonization of the intestinal tract". J. Clin. Microbiol. 26 (5): 1052–4. PMC 266519. PMID 3290234.
  16. ↑ Lindström M, Korkeala H (April 2006). "Laboratory diagnostics of botulism". Clin. Microbiol. Rev. 19 (2): 298–314. doi:10.1128/CMR.19.2.298-314.2006. PMC 1471988. PMID 16614251.
  17. ↑ Brook I (2006). "Botulism: the challenge of diagnosis and treatment". Rev Neurol Dis. 3 (4): 182–9. PMID 17224901.
  18. ↑ Dimachkie MM, Barohn RJ (May 2013). "Guillain-Barré syndrome and variants". Neurol Clin. 31 (2): 491–510. doi:10.1016/j.ncl.2013.01.005. PMC 3939842. PMID 23642721.
  19. ↑ Walling AD, Dickson G (February 2013). "Guillain-Barré syndrome". Am Fam Physician. 87 (3): 191–7. PMID 23418763.
  20. ↑ Gilhus NE (2011). "Lambert-eaton myasthenic syndrome; pathogenesis, diagnosis, and therapy". Autoimmune Dis. 2011: 973808. doi:10.4061/2011/973808. PMC 3182560. PMID 21969911.
  21. ↑ Krishnan C, Kaplin AI, Deshpande DM, Pardo CA, Kerr DA (May 2004). "Transverse Myelitis: pathogenesis, diagnosis and treatment". Front. Biosci. 9: 1483–99. PMID 14977560.
  22. ↑ Amato AA, Greenberg SA (December 2013). "Inflammatory myopathies". Continuum (Minneap Minn). 19 (6 Muscle Disease): 1615–33. doi:10.1212/01.CON.0000440662.26427.bd. PMID 24305450.
  23. ↑ 23.0 23.1 Berger JR, Dean D (2014). "Neurosyphilis". Handb Clin Neurol. 121: 1461–72. doi:10.1016/B978-0-7020-4088-7.00098-5. PMID 24365430.
  24. ↑ Talukder RK, Sutradhar SR, Rahman KM, Uddin MJ, Akhter H (2011). "Guillian-Barre syndrome". Mymensingh Med J. 20 (4): 748–56. PMID 22081202.
  25. ↑ Merino-Ramírez MÁ, Bolton CF (2016). "Review of the Diagnostic Challenges of Lambert-Eaton Syndrome Revealed Through Three Case Reports". Can J Neurol Sci. 43 (5): 635–47. doi:10.1017/cjn.2016.268. PMID 27412406.
  26. ↑ Gilhus NE (2016). "Myasthenia Gravis". N Engl J Med. 375 (26): 2570–2581. doi:10.1056/NEJMra1602678. PMID 28029925.
  27. ↑ Ozono K (2016). "[Diagnostic criteria for vitamin D-deficient rickets and hypocalcemia-]". Clin Calcium. 26 (2): 215–22. doi:CliCa1602215222 Check |doi= value (help). PMID 26813501.
  28. ↑ Kamanyire R, Karalliedde L (2004). "Organophosphate toxicity and occupational exposure". Occup Med (Lond). 54 (2): 69–75. PMID 15020723.
  29. ↑ Pecina CA (2012). "Tick paralysis". Semin Neurol. 32 (5): 531–2. doi:10.1055/s-0033-1334474. PMID 23677663.
  30. ↑ Bane V, Lehane M, Dikshit M, O'Riordan A, Furey A (2014). "Tetrodotoxin: chemistry, toxicity, source, distribution and detection". Toxins (Basel). 6 (2): 693–755. doi:10.3390/toxins6020693. PMC 3942760. PMID 24566728.
  31. ↑ Kuntzer T, Hirt L, Bogousslavsky J (1996). "[Neuromuscular involvement and cerebrovascular accidents]". Rev Med Suisse Romande. 116 (8): 605–9. PMID 8848683.
  32. ↑ Laffont I, Julia M, Tiffreau V, Yelnik A, Herisson C, Pelissier J (2010). "Aging and sequelae of poliomyelitis". Ann Phys Rehabil Med. 53 (1): 24–33. doi:10.1016/j.rehab.2009.10.002. PMID 19944665.
  33. ↑ West TW (2013). "Transverse myelitis--a review of the presentation, diagnosis, and initial management". Discov Med. 16 (88): 167–77. PMID 24099672.
  34. ↑ 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.
  35. ↑ 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.
  36. ↑ Falzarano MS, Scotton C, Passarelli C, Ferlini A (2015). "Duchenne Muscular Dystrophy: From Diagnosis to Therapy". Molecules. 20 (10): 18168–84. doi:10.3390/molecules201018168. PMID 26457695.
  37. ↑ Filippi M, Preziosa P, Rocca MA (2016). "Multiple sclerosis". Handb Clin Neurol. 135: 399–423. doi:10.1016/B978-0-444-53485-9.00020-9. PMID 27432676.
  38. ↑ 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.
  39. ↑ Riva N, Agosta F, Lunetta C, Filippi M, Quattrini A (2016). "Recent advances in amyotrophic lateral sclerosis". J Neurol. 263 (6): 1241–54. doi:10.1007/s00415-016-8091-6. PMC 4893385. PMID 27025851.
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