Acute disseminated encephalomyelitis differential diagnosis: Difference between revisions

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|'''Multiple sclerosis'''
|'''Multiple sclerosis'''
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|Sensory disturbances, walking difficulties, dizziness, vision problems, intestinal, urinary and sexual dysfunction, cognitive and emotional impairment<ref name="pmid24507522">{{cite journal| author=Gelfand JM| title=Multiple sclerosis: diagnosis, differential diagnosis, and clinical presentation. | journal=Handb Clin Neurol | year= 2014 | volume= 122 | issue=  | pages= 269-90 | pmid=24507522 | doi=10.1016/B978-0-444-52001-2.00011-X | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24507522  }}</ref>
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|MRI of the brain and spinal cord showing new lesions, both enhancing and non-enhancing, disseminated in space and time<ref name="pmid12566545">{{cite journal| author=Garg RK| title=Acute disseminated encephalomyelitis. | journal=Postgrad Med J | year= 2003 | volume= 79 | issue= 927 | pages= 11-7 | pmid=12566545 | doi=10.1136/pmj.79.927.11 | pmc=1742586 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12566545  }}</ref>; evoked potentials test demonstrate demyelination in the optic nerve and CNS<ref name="pmid10802774">{{cite journal| author=Gronseth GS, Ashman EJ| title=Practice parameter: the usefulness of evoked potentials in identifying clinically silent lesions in patients with suspected multiple sclerosis (an evidence-based review): Report of the Quality Standards Subcommittee of the American Academy of Neurology. | journal=Neurology | year= 2000 | volume= 54 | issue= 9 | pages= 1720-5 | pmid=10802774 | doi=10.1212/wnl.54.9.1720 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10802774  }}</ref>; Myelin basic protein and IgG oligoclonal bands on CSF analysis<ref name="pmid22904139">{{cite journal| author=Greene DN, Schmidt RL, Wilson AR, Freedman MS, Grenache DG| title=Cerebrospinal fluid myelin basic protein is frequently ordered but has little value: a test utilization study. | journal=Am J Clin Pathol | year= 2012 | volume= 138 | issue= 2 | pages= 262-72 | pmid=22904139 | doi=10.1309/AJCPCYCH96QYPHJM | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22904139  }}</ref>; vitamin deficiencies in blood sample<ref name="pmid21569549">{{cite journal| author=Shah I, James R, Barker J, Petroczi A, Naughton DP| title=Misleading measures in Vitamin D analysis: a novel LC-MS/MS assay to account for epimers and isobars. | journal=Nutr J | year= 2011 | volume= 10 | issue=  | pages= 46 | pmid=21569549 | doi=10.1186/1475-2891-10-46 | pmc=3114718 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21569549  }}</ref>.
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|T2-weighted MRI of the brain and spinal cord showing new patchy lesions, both enhancing and non-enhancing, disseminated in space and time<ref name="pmid12566545" />
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|Urinary tract infections, depression, social, vocational and psychological complications<ref name="pmid245075222">{{cite journal| author=Gelfand JM| title=Multiple sclerosis: diagnosis, differential diagnosis, and clinical presentation. | journal=Handb Clin Neurol | year= 2014 | volume= 122 | issue=  | pages= 269-90 | pmid=24507522 | doi=10.1016/B978-0-444-52001-2.00011-X | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24507522  }}</ref>
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|'''Antiphospholipid antibody syndrome'''
|'''Antiphospholipid antibody syndrome'''

Revision as of 11:14, 10 November 2022

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

Overview

Differential Diagnosis

Disease Clinical manifestations Para-clinical findings Gold standard Additional findings
Viral encephalitis [1] Can occur in any age characterised by fever and occasional prodromal illness Leukocytosis in blood; T2-weighted MRI shows multiple diffuse hyperintensities overlying the grey matter and white matter of bilateral cerebral cortices, and to a lesser extent the white matter, basal ganglia, brainstem and cerebellum; lymphocytic pleocytosis with elevated protein and normal glucose in CSF. CSF analysis for viral cultures and serological assays History of recent travel, animal bites (lyme disease/rabies), contact with childhood exanthema and polio, high-risk occupations and drug abuse; skin rashes (VZV,Measles, Rickettsia). HSV may cause fronto-temporal signs, aphasia, personality changes and focal seizures while myelitis is seen in polio infection.
HIV encephalopathy[2] Waxing and waning pattern of psychomotor retardation, decreased memory, concentration and attention span. Tremor, ataxia, hyperreflexia, hypertonia, progressive decline in MMSE scores[3]. Typical absence of cortical signs and symptoms Increase in CSF protein, cell count; multiple symmetric, hyperintense, non-enhancing subcortical foci on T2-weighted MRI[4]. Identification of HIV RNA in CSF Bowel and/or bladder complaints
Multiple sclerosis Sensory disturbances, walking difficulties, dizziness, vision problems, intestinal, urinary and sexual dysfunction, cognitive and emotional impairment[5] MRI of the brain and spinal cord showing new lesions, both enhancing and non-enhancing, disseminated in space and time[6]; evoked potentials test demonstrate demyelination in the optic nerve and CNS[7]; Myelin basic protein and IgG oligoclonal bands on CSF analysis[8]; vitamin deficiencies in blood sample[9]. T2-weighted MRI of the brain and spinal cord showing new patchy lesions, both enhancing and non-enhancing, disseminated in space and time[6] Urinary tract infections, depression, social, vocational and psychological complications[10]
Antiphospholipid antibody syndrome

References

  1. ↑ Kennedy PG (2004). "Viral encephalitis: causes, differential diagnosis, and management". J Neurol Neurosurg Psychiatry. 75 Suppl 1: i10–5. doi:10.1136/jnnp.2003.034280. PMC 1765650. PMID 14978145.
  2. ↑ "StatPearls". 2022. PMID 32310354 Check |pmid= value (help).
  3. ↑ Nir TM, Jahanshad N, Busovaca E, Wendelken L, Nicolas K, Thompson PM; et al. (2014). "Mapping white matter integrity in elderly people with HIV". Hum Brain Mapp. 35 (3): 975–92. doi:10.1002/hbm.22228. PMC 3775847. PMID 23362139.
  4. ↑ Valcour V, Paul R, Chiao S, Wendelken LA, Miller B (2011). "Screening for cognitive impairment in human immunodeficiency virus". Clin Infect Dis. 53 (8): 836–42. doi:10.1093/cid/cir524. PMC 3174098. PMID 21921226.
  5. ↑ Gelfand JM (2014). "Multiple sclerosis: diagnosis, differential diagnosis, and clinical presentation". Handb Clin Neurol. 122: 269–90. doi:10.1016/B978-0-444-52001-2.00011-X. PMID 24507522.
  6. ↑ 6.0 6.1 Garg RK (2003). "Acute disseminated encephalomyelitis". Postgrad Med J. 79 (927): 11–7. doi:10.1136/pmj.79.927.11. PMC 1742586. PMID 12566545.
  7. ↑ Gronseth GS, Ashman EJ (2000). "Practice parameter: the usefulness of evoked potentials in identifying clinically silent lesions in patients with suspected multiple sclerosis (an evidence-based review): Report of the Quality Standards Subcommittee of the American Academy of Neurology". Neurology. 54 (9): 1720–5. doi:10.1212/wnl.54.9.1720. PMID 10802774.
  8. ↑ Greene DN, Schmidt RL, Wilson AR, Freedman MS, Grenache DG (2012). "Cerebrospinal fluid myelin basic protein is frequently ordered but has little value: a test utilization study". Am J Clin Pathol. 138 (2): 262–72. doi:10.1309/AJCPCYCH96QYPHJM. PMID 22904139.
  9. ↑ Shah I, James R, Barker J, Petroczi A, Naughton DP (2011). "Misleading measures in Vitamin D analysis: a novel LC-MS/MS assay to account for epimers and isobars". Nutr J. 10: 46. doi:10.1186/1475-2891-10-46. PMC 3114718. PMID 21569549.
  10. ↑ Gelfand JM (2014). "Multiple sclerosis: diagnosis, differential diagnosis, and clinical presentation". Handb Clin Neurol. 122: 269–90. doi:10.1016/B978-0-444-52001-2.00011-X. PMID 24507522.

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