Sandbox:Akshun: Difference between revisions

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{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
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! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF|Cerebrospinal fluid level}}
! style="background: #4479BA; width: 350px;" | {{fontcolor|#FFF|Normal level}}
! style="background: #4479BA; width: 350px;" | {{fontcolor|#FFF|Bacterial meningitis}}
! style="background: #4479BA; width: 350px;" | {{fontcolor|#FFF|Viral meningitis}}<ref name="pmid10654948">{{cite journal| author=Negrini B, Kelleher KJ, Wald ER| title=Cerebrospinal fluid findings in aseptic versus bacterial meningitis. | journal=Pediatrics | year= 2000 | volume= 105 | issue= 2 | pages= 316-9 | pmid=10654948 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10654948  }} </ref>
! style="background: #4479BA; width: 350px;" | {{fontcolor|#FFF|Fungal meningitis}}
! style="background: #4479BA; width: 350px;" | {{fontcolor|#FFF|Tuberculous meningitis}}
! style="background: #4479BA; width: 350px;" | {{fontcolor|#FFF|Neoplastic meningitis}}
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''Cells/ul'''
| style="padding: 5px 5px; background: #F5F5F5;" |'''< 5'''
| style="padding: 5px 5px; background: #F5F5F5;" |'''>300'''
| style="padding: 5px 5px; background: #F5F5F5;" |'''10-1000'''
| style="padding: 5px 5px; background: #F5F5F5;" |'''10-500'''
| style="padding: 5px 5px; background: #F5F5F5;" |'''50-500'''
| style="padding: 5px 5px; background: #F5F5F5;" |'''>4'''
|-
| style="padding: 5px 5px; background: #DCDCDC;" |'''Cells'''
| style="padding: 5px 5px; background: #F5F5F5;" |'''[[Lymphocyte]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |'''[[Leukocyte]] > [[Lymphocyte]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |'''[[Lymphocyte]] > [[Leukocyte]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |'''[[Lymphocyte]] > [[Leukocyte]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |'''[[Lymphocyte]] > [[Leukocyte]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |'''[[Lymphocyte]] > [[Leukocyte]]'''
|-
| style="padding: 5px 5px; background: #DCDCDC;" |'''Total protein (mg/dl''')
| style="padding: 5px 5px; background: #F5F5F5;" |'''45-60'''
| style="padding: 5px 5px; background: #F5F5F5;" |'''Typically 100-500'''
| style="padding: 5px 5px; background: #F5F5F5;" | '''Normal or slightly high'''
| style="padding: 5px 5px; background: #F5F5F5;" |'''High'''
| style="padding: 5px 5px; background: #F5F5F5;" |'''Typically 100-200'''
| style="padding: 5px 5px; background: #F5F5F5;" |'''>50'''
|-
| style="padding: 5px 5px; background: #DCDCDC;" |'''Glucose ratio (CSF/plasma)'''
| style="padding: 5px 5px; background: #F5F5F5;" |'''> 0.5'''
| style="padding: 5px 5px; background: #F5F5F5;" |'''< 0.3'''
| style="padding: 5px 5px; background: #F5F5F5;" |'''> 0.6'''
| style="padding: 5px 5px; background: #F5F5F5;" |'''<0.3'''
| style="padding: 5px 5px; background: #F5F5F5;" |'''< 0.5'''
| style="padding: 5px 5px; background: #F5F5F5;" |'''<0.5'''
|-
| style="padding: 5px 5px; background: #DCDCDC;" |'''Lactate (mmols/l)'''
| style="padding: 5px 5px; background: #F5F5F5;" |'''< 2.1'''
| style="padding: 5px 5px; background: #F5F5F5;" |'''> 2.1'''
| style="padding: 5px 5px; background: #F5F5F5;" |'''< 2.1'''
| style="padding: 5px 5px; background: #F5F5F5;" |'''>3.2'''
| style="padding: 5px 5px; background: #F5F5F5;" |'''> 2.1'''
| style="padding: 5px 5px; background: #F5F5F5;" |'''>2.1'''
|-
| style="padding: 5px 5px; background: #DCDCDC;" |'''Others'''
| style="padding: 5px 5px; background: #F5F5F5;" |'''[[Intracranial pressure|Intra-cranial pressure]] (ICP) = 6-12 (cm H2O)'''
| style="padding: 5px 5px; background: #F5F5F5;" |'''CSF [[gram stain]], CSF culture, CSF bacterial antigen'''
| style="padding: 5px 5px; background: #F5F5F5;" |'''[[PCR]] of HSV-DNA, VZV'''
| style="padding: 5px 5px; background: #F5F5F5;" |'''CSF [[gram stain]], CSF india ink'''
| style="padding: 5px 5px; background: #F5F5F5;" |'''[[PCR]] of TB-DNA'''
| style="padding: 5px 5px; background: #F5F5F5;" |'''CSF tumour markers such as [[Alpha-fetoprotein|alpha fetoprotein]], [[CEA]]'''
|-
|}
|}
<references />
<references />

Revision as of 16:22, 20 July 2017


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Akshun Kalia M.B.B.S.[2]

Overview

Pituitary apoplexy must be differentiated from other diseases that cause severe headache such as subarachnoid hemorrhage, meningitis, cerebral hemorrhage, intracranial mass, infarction, intracranial venous thrombosis, migraine, cavernous sinus thrombosis, cerebellar hemorrhage and midbrain infarction.

Differentiating Pituitary apoplexy From Other Diseases

Pituitary apoplexy should be differentiated from other diseases causing severe headache for example:

Disease Symptoms Findings
Subarachnoid hemorrhage

Lumbar puncture (LP)

Lumbar puncture (LP) seems necessary when there is a strong suspicion of subarachnoid hemorrhage. Lumbar puncture (LP) is the most sensitive techniques to detect the blood in CSF especially 12 hours after onset of symptoms.[1][2]

The classic findings of subarachnoid hemorrhage may include:[3][4][5][6][7]

Meningitis Diagnosis of meningitis, is based on clinical presentation in combination with CSF analysis. CSF analysis has major role for diagnosis and rule out other possibilities. For more information on CSF analysis in meningitis please click here.
Intracranial Mass
  • Headache
  • Nausea
  • Vomiting
  • Change in mental status
  • Seizures
  • Focal symptoms of brain damage
  • Associated co-morbid conditions like tuberculosis, etc
Cerebral hemorrhage
  • Increased intracranial pressure (ICP) (headache, vomiting, and depressed level of consciousness) 
  • progression of focal neurological deficits over periods of hours
Infarction
Intracranial venous thrombosis
Severe headache with decreased visual acuity, ocular palsies, or visual field changes
Complicated migraine
Midbrain infarction
Cavernous sinus thrombosis
Cerebellar hemorrhage
Signs of hypopituitarism (hypogonadism, hypoadrenalism, or hypothyroidism)
Head injury
Lymphocytic hypophysitis
Iatrogenic surgical
Radiation injury
Infections (particularly tuberculosis and mycotic infections)