Acute disseminated encephalomyelitis differential diagnosis
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
- ↑ 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.
- ↑ "StatPearls". 2022. PMID 32310354 Check
|pmid=value (help). - ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 6.0 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.