Viral meningitis differential diagnosis: Difference between revisions
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[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Viral_meningitis]] | |||
{{CMG}}{{AE}}{{AEL}} | {{CMG}}{{AE}}{{AEL}} | ||
==Overview== | ==Overview== | ||
The differential diagnosis of viral meningitis includes two step approach. First is differentiating | The differential diagnosis of viral meningitis includes two step approach. First is differentiating viral meningitis from other diseases which have similar clinical presentation as viral meningitis such as [[encephalitis]], [[brain abscess]], [[subarachnoid]] hemorrage, and [[brain tumour]]. Second step involves [[CSF]] examination and differentiating viral meningitis from [[bacterial]], [[fungal]] and other causes of meningitis | ||
==Differential diagnosis== | ==Differential diagnosis== | ||
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Viral meningitis may mimick other diseases in terms of clinical signs and symptoms. It is important to differentiate viral meningitis from other diseases with similar presentation. Once the diagnsis of meningitis is confirmed, the next step may be to differentiate different types of meningitis on the basis of CSF examnination:<ref name="pmid20582303">{{cite journal| author=Stern TA, Celano CM, Gross AF, Huffman JC, Freudenreich O, Kontos N et al.| title=The assessment and management of agitation and delirium in the general hospital. | journal=Prim Care Companion J Clin Psychiatry | year= 2010 | volume= 12 | issue= 1 | pages= PCC.09r00938 | pmid=20582303 | doi=10.4088/PCC.09r00938yel | pmc=2882819 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20582303 }} </ref><ref name="pmid1278192">Soffer D (1976) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=1278192 Brain tumors simulating purulent meningitis.] ''Eur Neurol'' 14 (3):192-7. PMID: [http://pubmed.gov/1278192 1278192]</ref><ref name="pmid3883130">Terheggen HG (1985) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=3883130 [CNS tumors with the clinical picture of meningitis].] ''Monatsschr Kinderheilkd'' 133 (1):13-9. PMID: [http://pubmed.gov/3883130 3883130]</ref><ref name="pmid21371327">{{cite journal| author=Weston CL, Glantz MJ, Connor JR| title=Detection of cancer cells in the cerebrospinal fluid: current methods and future directions. | journal=Fluids Barriers CNS | year= 2011 | volume= 8 | issue= 1 | pages= 14 | pmid=21371327 | doi=10.1186/2045-8118-8-14 | pmc=3059292 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21371327 }}</ref><ref name="pmid1198628">{{cite journal| author=Lee MC, Heaney LM, Jacobson RL, Klassen AC| title=Cerebrospinal fluid in cerebral hemorrhage and infarction. | journal=Stroke | year= 1975 | volume= 6 | issue= 6 | pages= 638-41 | pmid=1198628 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1198628 }}</ref><ref name="pmid23177603">{{cite journal| author=Han JH, Wilber ST| title=Altered mental status in older patients in the emergency department. | journal=Clin Geriatr Med | year= 2013 | volume= 29 | issue= 1 | pages= 101-36 | pmid=23177603 | doi=10.1016/j.cger.2012.09.005 | pmc=3614410 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23177603 }} </ref><ref name="pmid21694755">{{cite journal| author=Birenbaum D, Bancroft LW, Felsberg GJ| title=Imaging in acute stroke. | journal=West J Emerg Med | year= 2011 | volume= 12 | issue= 1 | pages= 67-76 | pmid=21694755 | doi= | pmc=3088377 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21694755 }}</ref><ref name="pmid21807345">{{cite journal| author=DeLaPaz RL, Wippold FJ, Cornelius RS, Amin-Hanjani S, Angtuaco EJ, Broderick DF et al.| title=ACR Appropriateness Criteria® on cerebrovascular disease. | journal=J Am Coll Radiol | year= 2011 | volume= 8 | issue= 8 | pages= 532-8 | pmid=21807345 | doi=10.1016/j.jacr.2011.05.010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21807345 }}</ref><ref name="pmid7105615">{{cite journal| author=Stein MT, Trauner D| title=The child with a stiff neck. | journal=Clin Pediatr (Phila) | year= 1982 | volume= 21 | issue= 9 | pages= 559-63 | pmid=7105615 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7105615 }} </ref><ref name="pmid17968200">{{cite journal| author=De Cauwer HG, Eykens L, Hellinckx J, Mortelmans LJ| title=Differential diagnosis between viral and bacterial meningitis in children. | journal=Eur J Emerg Med | year= 2007 | volume= 14 | issue= 6 | pages= 343-7 | pmid=17968200 | doi=10.1097/MEJ.0b013e328270366b | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17968200 }} </ref><ref name="pmid2810603">{{cite journal| author=Spanos A, Harrell FE, Durack DT| title=Differential diagnosis of acute meningitis. An analysis of the predictive value of initial observations. | journal=JAMA | year= 1989 | volume= 262 | issue= 19 | pages= 2700-7 | pmid=2810603 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2810603 }} </ref><ref name="pmid3137038">{{cite journal| author=Lindquist L, Linné T, Hansson LO, Kalin M, Axelsson G| title=Value of cerebrospinal fluid analysis in the differential diagnosis of meningitis: a study in 710 patients with suspected central nervous system infection. | journal=Eur J Clin Microbiol Infect Dis | year= 1988 | volume= 7 | issue= 3 | pages= 374-80 | pmid=3137038 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3137038 }} </ref><ref name="pmid18984423">{{cite journal| author=Naganuma M, Fujioka S, Inatomi Y, Yonehara T, Hashimoto Y, Hirano T et al.| title=Clinical characteristics of subarachnoid hemorrhage with or without headache. | journal=J Stroke Cerebrovasc Dis | year= 2008 | volume= 17 | issue= 6 | pages= 334-9 | pmid=18984423 | doi=10.1016/j.jstrokecerebrovasdis.2008.04.009 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18984423 }} </ref><ref name="pmid10916131">{{cite journal| author=Rajnik M, Ottolini MG| title=Serious infections of the central nervous system: encephalitis, meningitis, and brain abscess. | journal=Adolesc Med | year= 2000 | volume= 11 | issue= 2 | pages= 401-25 | pmid=10916131 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10916131 }} </ref><ref name="pmid15319091">{{cite journal| author=Tyler KL| title=Herpes simplex virus infections of the central nervous system: encephalitis and meningitis, including Mollaret's. | journal=Herpes | year= 2004 | volume= 11 Suppl 2 | issue= | pages= 57A-64A | pmid=15319091 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15319091 }} </ref><ref name="pmid14978145">{{cite journal| author=Kennedy PG| title=Viral encephalitis: causes, differential diagnosis, and management. | journal=J Neurol Neurosurg Psychiatry | year= 2004 | volume= 75 Suppl 1 | issue= | pages= i10-5 | pmid=14978145 | doi= | pmc=1765650 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14978145 }} </ref> | Viral meningitis may mimick other diseases in terms of clinical signs and symptoms. It is important to differentiate viral meningitis from other diseases with similar presentation. Once the diagnsis of meningitis is confirmed, the next step may be to differentiate different types of meningitis on the basis of CSF examnination:<ref name="pmid20582303">{{cite journal| author=Stern TA, Celano CM, Gross AF, Huffman JC, Freudenreich O, Kontos N et al.| title=The assessment and management of agitation and delirium in the general hospital. | journal=Prim Care Companion J Clin Psychiatry | year= 2010 | volume= 12 | issue= 1 | pages= PCC.09r00938 | pmid=20582303 | doi=10.4088/PCC.09r00938yel | pmc=2882819 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20582303 }} </ref><ref name="pmid1278192">Soffer D (1976) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=1278192 Brain tumors simulating purulent meningitis.] ''Eur Neurol'' 14 (3):192-7. PMID: [http://pubmed.gov/1278192 1278192]</ref><ref name="pmid3883130">Terheggen HG (1985) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=3883130 [CNS tumors with the clinical picture of meningitis].] ''Monatsschr Kinderheilkd'' 133 (1):13-9. PMID: [http://pubmed.gov/3883130 3883130]</ref><ref name="pmid21371327">{{cite journal| author=Weston CL, Glantz MJ, Connor JR| title=Detection of cancer cells in the cerebrospinal fluid: current methods and future directions. | journal=Fluids Barriers CNS | year= 2011 | volume= 8 | issue= 1 | pages= 14 | pmid=21371327 | doi=10.1186/2045-8118-8-14 | pmc=3059292 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21371327 }}</ref><ref name="pmid1198628">{{cite journal| author=Lee MC, Heaney LM, Jacobson RL, Klassen AC| title=Cerebrospinal fluid in cerebral hemorrhage and infarction. | journal=Stroke | year= 1975 | volume= 6 | issue= 6 | pages= 638-41 | pmid=1198628 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1198628 }}</ref><ref name="pmid23177603">{{cite journal| author=Han JH, Wilber ST| title=Altered mental status in older patients in the emergency department. | journal=Clin Geriatr Med | year= 2013 | volume= 29 | issue= 1 | pages= 101-36 | pmid=23177603 | doi=10.1016/j.cger.2012.09.005 | pmc=3614410 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23177603 }} </ref><ref name="pmid21694755">{{cite journal| author=Birenbaum D, Bancroft LW, Felsberg GJ| title=Imaging in acute stroke. | journal=West J Emerg Med | year= 2011 | volume= 12 | issue= 1 | pages= 67-76 | pmid=21694755 | doi= | pmc=3088377 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21694755 }}</ref><ref name="pmid21807345">{{cite journal| author=DeLaPaz RL, Wippold FJ, Cornelius RS, Amin-Hanjani S, Angtuaco EJ, Broderick DF et al.| title=ACR Appropriateness Criteria® on cerebrovascular disease. | journal=J Am Coll Radiol | year= 2011 | volume= 8 | issue= 8 | pages= 532-8 | pmid=21807345 | doi=10.1016/j.jacr.2011.05.010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21807345 }}</ref><ref name="pmid7105615">{{cite journal| author=Stein MT, Trauner D| title=The child with a stiff neck. | journal=Clin Pediatr (Phila) | year= 1982 | volume= 21 | issue= 9 | pages= 559-63 | pmid=7105615 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7105615 }} </ref><ref name="pmid17968200">{{cite journal| author=De Cauwer HG, Eykens L, Hellinckx J, Mortelmans LJ| title=Differential diagnosis between viral and bacterial meningitis in children. | journal=Eur J Emerg Med | year= 2007 | volume= 14 | issue= 6 | pages= 343-7 | pmid=17968200 | doi=10.1097/MEJ.0b013e328270366b | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17968200 }} </ref><ref name="pmid2810603">{{cite journal| author=Spanos A, Harrell FE, Durack DT| title=Differential diagnosis of acute meningitis. An analysis of the predictive value of initial observations. | journal=JAMA | year= 1989 | volume= 262 | issue= 19 | pages= 2700-7 | pmid=2810603 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2810603 }} </ref><ref name="pmid3137038">{{cite journal| author=Lindquist L, Linné T, Hansson LO, Kalin M, Axelsson G| title=Value of cerebrospinal fluid analysis in the differential diagnosis of meningitis: a study in 710 patients with suspected central nervous system infection. | journal=Eur J Clin Microbiol Infect Dis | year= 1988 | volume= 7 | issue= 3 | pages= 374-80 | pmid=3137038 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3137038 }} </ref><ref name="pmid18984423">{{cite journal| author=Naganuma M, Fujioka S, Inatomi Y, Yonehara T, Hashimoto Y, Hirano T et al.| title=Clinical characteristics of subarachnoid hemorrhage with or without headache. | journal=J Stroke Cerebrovasc Dis | year= 2008 | volume= 17 | issue= 6 | pages= 334-9 | pmid=18984423 | doi=10.1016/j.jstrokecerebrovasdis.2008.04.009 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18984423 }} </ref><ref name="pmid10916131">{{cite journal| author=Rajnik M, Ottolini MG| title=Serious infections of the central nervous system: encephalitis, meningitis, and brain abscess. | journal=Adolesc Med | year= 2000 | volume= 11 | issue= 2 | pages= 401-25 | pmid=10916131 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10916131 }} </ref><ref name="pmid15319091">{{cite journal| author=Tyler KL| title=Herpes simplex virus infections of the central nervous system: encephalitis and meningitis, including Mollaret's. | journal=Herpes | year= 2004 | volume= 11 Suppl 2 | issue= | pages= 57A-64A | pmid=15319091 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15319091 }} </ref><ref name="pmid14978145">{{cite journal| author=Kennedy PG| title=Viral encephalitis: causes, differential diagnosis, and management. | journal=J Neurol Neurosurg Psychiatry | year= 2004 | volume= 75 Suppl 1 | issue= | pages= i10-5 | pmid=14978145 | doi= | pmc=1765650 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14978145 }} </ref> | ||
===Differentiating | ===Differentiating viral meningitis from other diseases=== | ||
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!<small>Altered mental status</small> | !<small>Altered mental status</small> | ||
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|style="background: #DCDCDC; padding: 5px; text-align: center;" | Brain tumour<ref name="pmid1278192">Soffer D (1976) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=1278192 Brain tumors simulating purulent meningitis.] ''Eur Neurol'' 14 (3):192-7. PMID: [http://pubmed.gov/1278192 1278192]</ref><ref name="pmid3883130" /> | |style="background: #DCDCDC; padding: 5px; text-align: center;" | [[Brain tumor|Brain tumour]]<ref name="pmid1278192">Soffer D (1976) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=1278192 Brain tumors simulating purulent meningitis.] ''Eur Neurol'' 14 (3):192-7. PMID: [http://pubmed.gov/1278192 1278192]</ref><ref name="pmid3883130" /> | ||
|style="background: #F5F5F5; padding: 5px;" | | |style="background: #F5F5F5; padding: 5px;" | | ||
|style="background: #F5F5F5; padding: 5px; text-align:center"| | |style="background: #F5F5F5; padding: 5px; text-align:center"| + | ||
|style="background: #F5F5F5; padding: 5px text-align:center" |Cancer cells<ref name="pmid21371327">{{cite journal| author=Weston CL, Glantz MJ, Connor JR| title=Detection of cancer cells in the cerebrospinal fluid: current methods and future directions. | journal=Fluids Barriers CNS | year= 2011 | volume= 8 | issue= 1 | pages= 14 | pmid=21371327 | doi=10.1186/2045-8118-8-14 | pmc=3059292 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21371327 }}</ref> | |style="background: #F5F5F5; padding: 5px text-align:center" |[[Cancer cells]]<ref name="pmid21371327">{{cite journal| author=Weston CL, Glantz MJ, Connor JR| title=Detection of cancer cells in the cerebrospinal fluid: current methods and future directions. | journal=Fluids Barriers CNS | year= 2011 | volume= 8 | issue= 1 | pages= 14 | pmid=21371327 | doi=10.1186/2045-8118-8-14 | pmc=3059292 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21371327 }}</ref> | ||
|style="background: #F5F5F5; padding: 5px;" |MRI | |style="background: #F5F5F5; padding: 5px;" |MRI | ||
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|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" | | |style="background: #F5F5F5; padding: 5px;text-align:center" | + | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" | | | style="background: #F5F5F5; padding: 5px; text-align:center" | + | ||
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|style="background: #F5F5F5; padding: 5px;" |[[Cachexia]], gradual progression of symptoms | |style="background: #F5F5F5; padding: 5px;" |[[Cachexia]], gradual progression of symptoms | ||
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|style="background: #DCDCDC; padding: 5px; text-align: center;" |Delerium Tremens | |style="background: #DCDCDC; padding: 5px; text-align: center;" |Delerium Tremens | ||
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| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
| style="background: #F5F5F5; padding: 5px;" |Clinical diagnosis | | style="background: #F5F5F5; padding: 5px;" |Clinical diagnosis | ||
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| 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" | | | style="background: #F5F5F5; padding: 5px; text-align:center" | + | ||
|style="background: #F5F5F5; padding: 5px; text-align:center" | | |style="background: #F5F5F5; padding: 5px; text-align:center" | + | ||
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|style="background: #F5F5F5; padding: 5px;" |Alcohal intake, sudden witdrawl or reduction in consumption | |style="background: #F5F5F5; padding: 5px;" |Alcohal intake, sudden witdrawl or reduction in consumption | ||
|style="background: #F5F5F5; padding: 5px;" |Tachycardia, diaphoresis, hypertension, tremors, mydriasis, positional nystagmus, tachypnea | |style="background: #F5F5F5; padding: 5px;" |[[Tachycardia]], [[diaphoresis]], [[hypertension]], [[tremors]], [[mydriasis]], [[positional nystagmus]], [[tachypnea]] | ||
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|style="background: #DCDCDC; padding: 5px; text-align: center;" | Subarachnoid hemorrhage<ref name="pmid14585453">Yeh ST, Lee WJ, Lin HJ, Chen CY, Te AL, Lin HJ (2003) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=14585453 Nonaneurysmal subarachnoid hemorrhage secondary to tuberculous meningitis: report of two cases.] ''J Emerg Med'' 25 (3):265-70. PMID: [http://pubmed.gov/14585453 14585453]</ref> | |style="background: #DCDCDC; padding: 5px; text-align: center;" | [[Subarachnoid hemorrhage|Subarachnoid hemorrhage]]<ref name="pmid14585453">Yeh ST, Lee WJ, Lin HJ, Chen CY, Te AL, Lin HJ (2003) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=14585453 Nonaneurysmal subarachnoid hemorrhage secondary to tuberculous meningitis: report of two cases.] ''J Emerg Med'' 25 (3):265-70. PMID: [http://pubmed.gov/14585453 14585453]</ref> | ||
|style="background: #F5F5F5; padding: 5px;" | | |style="background: #F5F5F5; padding: 5px;" | | ||
|style="background: #F5F5F5; padding: 5px; text-align:center" | | |style="background: #F5F5F5; padding: 5px; text-align:center" | + | ||
|style="background: #F5F5F5; padding: 5px;" |Xanthochromia<ref name="pmid1198628">{{cite journal| author=Lee MC, Heaney LM, Jacobson RL, Klassen AC| title=Cerebrospinal fluid in cerebral hemorrhage and infarction. | journal=Stroke | year= 1975 | volume= 6 | issue= 6 | pages= 638-41 | pmid=1198628 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1198628 }}</ref> | |style="background: #F5F5F5; padding: 5px;" |Xanthochromia<ref name="pmid1198628">{{cite journal| author=Lee MC, Heaney LM, Jacobson RL, Klassen AC| title=Cerebrospinal fluid in cerebral hemorrhage and infarction. | journal=Stroke | year= 1975 | volume= 6 | issue= 6 | pages= 638-41 | pmid=1198628 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1198628 }}</ref> | ||
|style="background: #F5F5F5; padding: 5px;" |CT scan without contrast<ref name="pmid21694755">{{cite journal| author=Birenbaum D, Bancroft LW, Felsberg GJ| title=Imaging in acute stroke. | journal=West J Emerg Med | year= 2011 | volume= 12 | issue= 1 | pages= 67-76 | pmid=21694755 | doi= | pmc=3088377 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21694755 }}</ref><ref name="pmid21807345">{{cite journal| author=DeLaPaz RL, Wippold FJ, Cornelius RS, Amin-Hanjani S, Angtuaco EJ, Broderick DF et al.| title=ACR Appropriateness Criteria® on cerebrovascular disease. | journal=J Am Coll Radiol | year= 2011 | volume= 8 | issue= 8 | pages= 532-8 | pmid=21807345 | doi=10.1016/j.jacr.2011.05.010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21807345 }}</ref> | |style="background: #F5F5F5; padding: 5px;" |CT scan without contrast<ref name="pmid21694755">{{cite journal| author=Birenbaum D, Bancroft LW, Felsberg GJ| title=Imaging in acute stroke. | journal=West J Emerg Med | year= 2011 | volume= 12 | issue= 1 | pages= 67-76 | pmid=21694755 | doi= | pmc=3088377 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21694755 }}</ref><ref name="pmid21807345">{{cite journal| author=DeLaPaz RL, Wippold FJ, Cornelius RS, Amin-Hanjani S, Angtuaco EJ, Broderick DF et al.| title=ACR Appropriateness Criteria® on cerebrovascular disease. | journal=J Am Coll Radiol | year= 2011 | volume= 8 | issue= 8 | pages= 532-8 | pmid=21807345 | doi=10.1016/j.jacr.2011.05.010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21807345 }}</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" | | |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" | + | ||
|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" | | |style="background: #F5F5F5; padding: 5px; text-align:center" | + | ||
|style="background: #F5F5F5; padding: 5px;" |Trauma/fall | |style="background: #F5F5F5; padding: 5px;" |Trauma/fall | ||
|style="background: #F5F5F5; padding: 5px;" |Confusion, dizziness, nausea, vomiting | |style="background: #F5F5F5; padding: 5px;" |[[Confusion]], [[dizziness]], [[nausea]], [[vomiting]] | ||
|- | |- | ||
|style="background: #DCDCDC; padding: 5px; text-align: center;" | Stroke | |style="background: #DCDCDC; padding: 5px; text-align: center;" | [[Stroke]] | ||
|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"| Normal | |style="background: #F5F5F5; padding: 5px; text-align:center"| Normal | ||
|style="background: #F5F5F5; padding: 5px; text-align:center"| CT scan without contrast | |style="background: #F5F5F5; padding: 5px; text-align:center"| CT scan without contrast | ||
|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"| | |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"| + | ||
|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"| | |style="background: #F5F5F5; padding: 5px; text-align:center"| + | ||
|style="background: #F5F5F5; padding: 5px; text-align:center"|TIAs, hypertension, diabetes mellitus | |style="background: #F5F5F5; padding: 5px; text-align:center"|TIAs, hypertension, [[diabetes mellitus]] | ||
|style="background: #F5F5F5; padding: 5px; text-align:center"|Speech difficulty, gait abnormality | |style="background: #F5F5F5; padding: 5px; text-align:center"|Speech difficulty, gait abnormality | ||
|- | |- | ||
|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: #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;" | | |style="background: #F5F5F5; padding: 5px;" | | ||
|style="background: #F5F5F5; padding: 5px; text-align:center" | | |style="background: #F5F5F5; padding: 5px; text-align:center" | + | ||
|style="background: #F5F5F5; padding: 5px;" |'''↑''' [[Leukocytes]] and [[protein]] | |style="background: #F5F5F5; padding: 5px;" |'''↑''' [[Leukocytes]] and [[protein]] | ||
|style="background: #F5F5F5; padding: 5px;" |CSF [[VDRL]]-specifc | |style="background: #F5F5F5; padding: 5px;" |CSF [[VDRL]]-specifc | ||
CSF 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> | CSF 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" | | |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" | + | ||
|style="background: #F5F5F5; padding: 5px;text-align:center" | | |style="background: #F5F5F5; padding: 5px;text-align:center" | + | ||
|style="background: #F5F5F5; padding: 5px;" | | |style="background: #F5F5F5; padding: 5px;" | | ||
|style="background: #F5F5F5; padding: 5px; text-align:center" | | |style="background: #F5F5F5; padding: 5px; text-align:center" | + | ||
|style="background: #F5F5F5; padding: 5px;" | | |style="background: #F5F5F5; padding: 5px;" | | ||
|style="background: #F5F5F5; padding: 5px; text-align:center" | | |style="background: #F5F5F5; padding: 5px; text-align:center" | + | ||
|style="background: #F5F5F5; padding: 5px;" |Unprotected sexual intercourse, STIs | |style="background: #F5F5F5; padding: 5px;" |Unprotected sexual intercourse, STIs | ||
|style="background: #F5F5F5; padding: 5px;" |Blindness, confusion, [[depression]], | |style="background: #F5F5F5; padding: 5px;" |[[Blindness]], [[confusion]], [[depression]], | ||
Abnormal [[gait]] | Abnormal [[gait]] | ||
| Line 120: | Line 120: | ||
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Viral encephalitis | |style="background: #DCDCDC; padding: 5px; text-align: center;" |Viral encephalitis | ||
|style="background: #F5F5F5; padding: 5px;" | | |style="background: #F5F5F5; padding: 5px;" | | ||
|style="background: #F5F5F5; padding: 5px;" | | |style="background: #F5F5F5; padding: 5px;" | + | ||
|style="background: #F5F5F5; padding: 5px;" |Increased RBCS or xanthochromia, mononuclear lymphocytosis, high protein content, normal glucose | |style="background: #F5F5F5; padding: 5px;" |Increased RBCS or xanthochromia, mononuclear lymphocytosis, high protein content, normal glucose | ||
|style="background: #F5F5F5; padding: 5px;" |Clinical assesment | |style="background: #F5F5F5; padding: 5px;" |Clinical assesment | ||
|style="background: #F5F5F5; padding: 5px;" | | |style="background: #F5F5F5; padding: 5px;" | + | ||
|style="background: #F5F5F5; padding: 5px;" | | |style="background: #F5F5F5; padding: 5px;" | + | ||
|style="background: #F5F5F5; padding: 5px;text-align:center" | | |style="background: #F5F5F5; padding: 5px;text-align:center" | + | ||
|style="background: #F5F5F5; padding: 5px;" | | |style="background: #F5F5F5; padding: 5px;" | | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | + | ||
|style="background: #F5F5F5; padding: 5px; text-align:center" | | |style="background: #F5F5F5; padding: 5px; text-align:center" | + | ||
|style="background: #F5F5F5; padding: 5px;" | | |style="background: #F5F5F5; padding: 5px;" | + | ||
|style="background: #F5F5F5; padding: 5px;" | | |style="background: #F5F5F5; padding: 5px;" | + | ||
| style="background: #F5F5F5; padding: 5px;" |Tick bite/mosquito bite/ viral prodome for several days | | style="background: #F5F5F5; padding: 5px;" |Tick bite/mosquito bite/ viral prodome for several days | ||
| style="background: #F5F5F5; padding: 5px;" |Extreme lethargy, rash hepatosplenomegaly, lymphadenopathy, | | style="background: #F5F5F5; padding: 5px;" |Extreme [[lethargy]], [[rash]] [[hepatosplenomegaly]], [[lymphadenopathy]], behavioral changes | ||
|- | |- | ||
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Herpes simplex encephalitis | |style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Herpes simplex encephalitis]] | ||
|style="background: #F5F5F5; padding: 5px;" | | |style="background: #F5F5F5; padding: 5px;" | | ||
|style="background: #F5F5F5; padding: 5px;" | | |style="background: #F5F5F5; padding: 5px;" | + | ||
|style="background: #F5F5F5; padding: 5px;" | | |style="background: #F5F5F5; padding: 5px;" | | ||
|style="background: #F5F5F5; padding: 5px;" |Clinical assesment | |style="background: #F5F5F5; padding: 5px;" |Clinical assesment | ||
|style="background: #F5F5F5; padding: 5px;" | | |style="background: #F5F5F5; padding: 5px;" | | ||
|style="background: #F5F5F5; padding: 5px;" | | |style="background: #F5F5F5; padding: 5px;" | | ||
|style="background: #F5F5F5; padding: 5px;" | | |style="background: #F5F5F5; padding: 5px;" | + | ||
|style="background: #F5F5F5; padding: 5px;" | | |style="background: #F5F5F5; padding: 5px;" | + | ||
|style="background: #F5F5F5; padding: 5px;" | | |style="background: #F5F5F5; padding: 5px;" | + | ||
|style="background: #F5F5F5; padding: 5px;" | | |style="background: #F5F5F5; padding: 5px;" | + | ||
|style="background: #F5F5F5; padding: 5px;" | | |style="background: #F5F5F5; padding: 5px;" | + | ||
|style="background: #F5F5F5; padding: 5px;" | | |style="background: #F5F5F5; padding: 5px;" | | ||
|style="background: #F5F5F5; padding: 5px;" |History of hypertension | |style="background: #F5F5F5; padding: 5px;" |History of hypertension | ||
|style="background: #F5F5F5; padding: 5px;" |Delirium, cortical blindness, cerebral edema, seizure | |style="background: #F5F5F5; padding: 5px;" |[[Delirium]], [[cortical blindness]], [[cerebral edema]], [[seizure]] | ||
|- | |- | ||
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Wernicke’s encephalopathy | |style="background: #DCDCDC; padding: 5px; text-align: center;" |Wernicke’s encephalopathy | ||
| Line 157: | Line 157: | ||
|style="background: #F5F5F5; padding: 5px;" | | |style="background: #F5F5F5; padding: 5px;" | | ||
|style="background: #F5F5F5; padding: 5px;" | | |style="background: #F5F5F5; padding: 5px;" | | ||
|style="background: #F5F5F5; padding: 5px;" | | |style="background: #F5F5F5; padding: 5px;" | + | ||
|style="background: #F5F5F5; padding: 5px;" | | |style="background: #F5F5F5; padding: 5px;" | + | ||
|style="background: #F5F5F5; padding: 5px;" | | |style="background: #F5F5F5; padding: 5px;" | | ||
|style="background: #F5F5F5; padding: 5px;" | | |style="background: #F5F5F5; padding: 5px;" | | ||
|style="background: #F5F5F5; padding: 5px;" | | |style="background: #F5F5F5; padding: 5px;" | + | ||
|style="background: #F5F5F5; padding: 5px;" | | |style="background: #F5F5F5; padding: 5px;" | | ||
|style="background: #F5F5F5; padding: 5px;" |History of alcohal abuse | |style="background: #F5F5F5; padding: 5px;" |History of alcohal abuse | ||
|style="background: #F5F5F5; padding: 5px;" |Ophthalmoplegia, confusion | |style="background: #F5F5F5; padding: 5px;" |[[Ophthalmoplegia]], [[confusion]] | ||
|- | |- | ||
|style="background: #DCDCDC; padding: 5px; text-align: center;" |CNS abscess | |style="background: #DCDCDC; padding: 5px; text-align: center;" |[[CNS abscess]] | ||
|style="background: #F5F5F5; padding: 5px;" | | |style="background: #F5F5F5; padding: 5px;" | | ||
|style="background: #F5F5F5; padding: 5px;" | | |style="background: #F5F5F5; padding: 5px;" | + | ||
|style="background: #F5F5F5; padding: 5px;" |'''↑''' leukocytes >100,000/ul, '''↓''' glucose and '''↑''' protien, '''↑''' red blood cells, lactic acid >500mg | |style="background: #F5F5F5; padding: 5px;" |'''↑''' leukocytes >100,000/ul, '''↓''' glucose and '''↑''' protien, '''↑''' red blood cells, lactic acid >500mg | ||
|style="background: #F5F5F5; padding: 5px;" |Contrast enhanced MRI is more sensitive and specific, | |style="background: #F5F5F5; padding: 5px;" |Contrast enhanced MRI is more sensitive and specific, | ||
Histopathological examination of brain tissue | Histopathological examination of brain tissue | ||
|style="background: #F5F5F5; padding: 5px;" | | |style="background: #F5F5F5; padding: 5px;" | + | ||
|style="background: #F5F5F5; padding: 5px;" | | |style="background: #F5F5F5; padding: 5px;" | + | ||
|style="background: #F5F5F5; padding: 5px;" | | |style="background: #F5F5F5; padding: 5px;" | + | ||
|style="background: #F5F5F5; padding: 5px;" | | |style="background: #F5F5F5; padding: 5px;" | | ||
|style="background: #F5F5F5; padding: 5px;" | | |style="background: #F5F5F5; padding: 5px;" | + | ||
|style="background: #F5F5F5; padding: 5px;" | | |style="background: #F5F5F5; padding: 5px;" | + | ||
|style="background: #F5F5F5; padding: 5px;" | | |style="background: #F5F5F5; padding: 5px;" | + | ||
|style="background: #F5F5F5; padding: 5px;" | | |style="background: #F5F5F5; padding: 5px;" | + | ||
|style="background: #F5F5F5; padding: 5px;" |History of drug abuse, endocarditis, '''↓''' immune status | |style="background: #F5F5F5; padding: 5px;" |History of drug abuse, endocarditis, '''↓''' immune status | ||
|style="background: #F5F5F5; padding: 5px;" |High grade fever, fatigue,nausea, vomiting | |style="background: #F5F5F5; padding: 5px;" |High grade fever, fatigue,nausea, vomiting | ||
|- | |- | ||
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Drug toxicity | |style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Drug toxicity]] | ||
|style="background: #F5F5F5; padding: 5px;" | | |style="background: #F5F5F5; padding: 5px;" | | ||
|style="background: #F5F5F5; padding: 5px;" | | |style="background: #F5F5F5; padding: 5px;" | | ||
| Line 194: | Line 194: | ||
|style="background: #F5F5F5; padding: 5px;" | | |style="background: #F5F5F5; padding: 5px;" | | ||
|style="background: #F5F5F5; padding: 5px;" | | |style="background: #F5F5F5; padding: 5px;" | | ||
|style="background: #F5F5F5; padding: 5px;" | | |style="background: #F5F5F5; padding: 5px;" | + | ||
|style="background: #F5F5F5; padding: 5px;" | | |style="background: #F5F5F5; padding: 5px;" | + | ||
|style="background: #F5F5F5; padding: 5px;" | | |style="background: #F5F5F5; padding: 5px;" | | ||
|style="background: #F5F5F5; padding: 5px;" |Lithium, Sedatives, phenytoin, carbamazepine | |style="background: #F5F5F5; padding: 5px;" |Lithium, Sedatives, phenytoin, carbamazepine | ||
|- | |- | ||
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Conversion disorder | |style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Conversion disorder]] | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
|style="background: #F5F5F5; padding: 5px;" | | |style="background: #F5F5F5; padding: 5px;" | | ||
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|style="background: #F5F5F5; padding: 5px;" |Diagnosis of exclusion | |style="background: #F5F5F5; padding: 5px;" |Diagnosis of exclusion | ||
| 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" | | | 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;" | | |style="background: #F5F5F5; padding: 5px;" | | ||
| 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" | | |style="background: #F5F5F5; padding: 5px; text-align:center" | + | ||
|style="background: #F5F5F5; padding: 5px;" | | |style="background: #F5F5F5; padding: 5px;" | | ||
|style="background: #F5F5F5; padding: 5px;" |[[Tremor|Tremors]], [[blindness]], difficulty [[swallowing]] | |style="background: #F5F5F5; padding: 5px;" |[[Tremor|Tremors]], [[blindness]], difficulty [[swallowing]] | ||
|- | |- | ||
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Electrolyte disturbance | |style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Electrolyte disturbance]] | ||
|style="background: #F5F5F5; padding: 5px; text-align:center" |'''↓''' or '''↑''' | |style="background: #F5F5F5; padding: 5px; text-align:center" |'''↓''' or '''↑''' | ||
|style="background: #F5F5F5; padding: 5px;" | | |style="background: #F5F5F5; padding: 5px;" | | ||
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|style="background: #F5F5F5; padding: 5px;" | | |style="background: #F5F5F5; padding: 5px;" | + | ||
|style="background: #F5F5F5; padding: 5px;" | | |style="background: #F5F5F5; padding: 5px;" | | ||
|style="background: #F5F5F5; padding: 5px;" | | |style="background: #F5F5F5; padding: 5px;" | + | ||
|style="background: #F5F5F5; padding: 5px;" | | |style="background: #F5F5F5; padding: 5px;" | | ||
|style="background: #F5F5F5; padding: 5px;" |Confusion, seizures | |style="background: #F5F5F5; padding: 5px;" |Confusion, seizures | ||
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| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
| 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;" | | | style="background: #F5F5F5; padding: 5px;" | + | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | + | ||
| style="background: #F5F5F5; padding: 5px;" |Family history of febrile seizures, viral illness or gastroenteritis | | style="background: #F5F5F5; padding: 5px;" |Family history of febrile seizures, viral illness or gastroenteritis | ||
| style="background: #F5F5F5; padding: 5px;" |Age > 1 month, | | style="background: #F5F5F5; padding: 5px;" |Age > 1 month, | ||
|- | |- | ||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Subdural empyema | | style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Subdural empyema]] | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
| 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;" |Clinical assesment and [[MRI]] | | style="background: #F5F5F5; padding: 5px;" |Clinical assesment and [[MRI]] | ||
| 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;" | | | style="background: #F5F5F5; padding: 5px;" | + | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | + | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" | | | style="background: #F5F5F5; padding: 5px; text-align:center" | + | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
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| style="background: #F5F5F5; padding: 5px; text-align:center" | | | style="background: #F5F5F5; padding: 5px; text-align:center" | + | ||
| style="background: #F5F5F5; padding: 5px;" |History of relapses and remissions | | style="background: #F5F5F5; padding: 5px;" |History of relapses and remissions | ||
| style="background: #F5F5F5; padding: 5px;" |Blurry vision, [[urinary incontinence]], [[fatigue]] | | style="background: #F5F5F5; padding: 5px;" |Blurry vision, [[urinary incontinence]], [[fatigue]] | ||
|- | |- | ||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Hypoglycemia | | style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Hypoglycemia]] | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" |↓ or '''↑''' | | style="background: #F5F5F5; padding: 5px; text-align:center" |↓ or '''↑''' | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
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[[HbA1c]] | [[HbA1c]] | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | + | ||
| 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;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
| 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;" | | | style="background: #F5F5F5; padding: 5px;" | + | ||
| style="background: #F5F5F5; padding: 5px;" |History of [[Diabetes mellitus|diabetes]] | | style="background: #F5F5F5; padding: 5px;" |History of [[Diabetes mellitus|diabetes]] | ||
| style="background: #F5F5F5; padding: 5px;" |[[Palpitation|Palpitations]], sweating, [[dizziness]], low serum, glucose | | style="background: #F5F5F5; padding: 5px;" |[[Palpitation|Palpitations]], sweating, [[dizziness]], low serum, glucose | ||
|} | |} | ||
===Differentiating | ===Differentiating viral meningitis from other causes of meningitis=== | ||
Bacterial meningitis may be differntiated from other causes of meningitis by cerebrospinal fluid examination:<ref name="pmid23717798">{{cite journal| author=Le Rhun E, Taillibert S, Chamberlain MC| title=Carcinomatous meningitis: Leptomeningeal metastases in solid tumors. | journal=Surg Neurol Int | year= 2013 | volume= 4 | issue= Suppl 4 | pages= S265-88 | pmid=23717798 | doi=10.4103/2152-7806.111304 | pmc=3656567 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23717798 }} </ref><ref name="pmid24326618">{{cite journal| author=Chow E, Troy SB| title=The differential diagnosis of hypoglycorrhachia in adult patients. | journal=Am J Med Sci | year= 2014 | volume= 348 | issue= 3 | pages= 186-90 | pmid=24326618 | doi=10.1097/MAJ.0000000000000217 | pmc=4065645 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24326618 }} </ref><ref name="pmid22880096">{{cite journal| author=Leen WG, Willemsen MA, Wevers RA, Verbeek MM| title=Cerebrospinal fluid glucose and lactate: age-specific reference values and implications for clinical practice. | journal=PLoS One | year= 2012 | volume= 7 | issue= 8 | pages= e42745 | pmid=22880096 | doi=10.1371/journal.pone.0042745 | pmc=3412827 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22880096 }} </ref><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><ref name="pmid20610819">{{cite journal| author=Brouwer MC, Tunkel AR, van de Beek D| title=Epidemiology, diagnosis, and antimicrobial treatment of acute bacterial meningitis. | journal=Clin Microbiol Rev | year= 2010 | volume= 23 | issue= 3 | pages= 467-92 | pmid=20610819 | doi=10.1128/CMR.00070-09 | pmc=2901656 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20610819 }} </ref> | Bacterial meningitis may be differntiated from other causes of meningitis by cerebrospinal fluid examination:<ref name="pmid23717798">{{cite journal| author=Le Rhun E, Taillibert S, Chamberlain MC| title=Carcinomatous meningitis: Leptomeningeal metastases in solid tumors. | journal=Surg Neurol Int | year= 2013 | volume= 4 | issue= Suppl 4 | pages= S265-88 | pmid=23717798 | doi=10.4103/2152-7806.111304 | pmc=3656567 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23717798 }} </ref><ref name="pmid24326618">{{cite journal| author=Chow E, Troy SB| title=The differential diagnosis of hypoglycorrhachia in adult patients. | journal=Am J Med Sci | year= 2014 | volume= 348 | issue= 3 | pages= 186-90 | pmid=24326618 | doi=10.1097/MAJ.0000000000000217 | pmc=4065645 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24326618 }} </ref><ref name="pmid22880096">{{cite journal| author=Leen WG, Willemsen MA, Wevers RA, Verbeek MM| title=Cerebrospinal fluid glucose and lactate: age-specific reference values and implications for clinical practice. | journal=PLoS One | year= 2012 | volume= 7 | issue= 8 | pages= e42745 | pmid=22880096 | doi=10.1371/journal.pone.0042745 | pmc=3412827 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22880096 }} </ref><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><ref name="pmid20610819">{{cite journal| author=Brouwer MC, Tunkel AR, van de Beek D| title=Epidemiology, diagnosis, and antimicrobial treatment of acute bacterial meningitis. | journal=Clin Microbiol Rev | year= 2010 | volume= 23 | issue= 3 | pages= 467-92 | pmid=20610819 | doi=10.1128/CMR.00070-09 | pmc=2901656 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20610819 }} </ref> | ||
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center | {| style="border: 0px; font-size: 90%; margin: 3px;" align=center | ||
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==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
[[Category:Emergency mdicine]] | |||
[[Category:Disease]] | |||
[[Category:Up-To-Date]] | |||
[[Category:Infectious disease]] | |||
[[Category:Neurology]] | |||
Latest revision as of 00:41, 30 July 2020
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Ahmed Elsaiey, MBBCH [2]
Overview
The differential diagnosis of viral meningitis includes two step approach. First is differentiating viral meningitis from other diseases which have similar clinical presentation as viral meningitis such as encephalitis, brain abscess, subarachnoid hemorrage, and brain tumour. Second step involves CSF examination and differentiating viral meningitis from bacterial, fungal and other causes of meningitis
Differential diagnosis
Differentiating viral meningitis from other diseases
Viral meningitis may mimick other diseases in terms of clinical signs and symptoms. It is important to differentiate viral meningitis from other diseases with similar presentation. Once the diagnsis of meningitis is confirmed, the next step may be to differentiate different types of meningitis on the basis of CSF examnination:[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16]
Differentiating viral meningitis from other diseases
| Diseases | Diagnostic tests | Physical Examination | Symptoms | Past medical history | Other Findings | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Na+, K+, Ca2+ | CT /MRI | CSF Findings | Gold standard test | Neck stiffness | Motor or Sensory deficit | Papilledema | Bulging fontanelle | Cranial nerves | Headache | Fever | Altered mental status | |||
| Brain tumour[2][3] | + | Cancer cells[4] | MRI | + | + | + | + | + | + | Cachexia, gradual progression of symptoms | ||||
| Delerium Tremens | + | Clinical diagnosis | + | + | + | + | + | + | Alcohal intake, sudden witdrawl or reduction in consumption | Tachycardia, diaphoresis, hypertension, tremors, mydriasis, positional nystagmus, tachypnea | ||||
| Subarachnoid hemorrhage[17] | + | Xanthochromia[5] | CT scan without contrast[7][8] | + | + | + | + | + | + | + | + | Trauma/fall | Confusion, dizziness, nausea, vomiting | |
| Stroke | + | Normal | CT scan without contrast | + | + | + | + | + | TIAs, hypertension, diabetes mellitus | Speech difficulty, gait abnormality | ||||
| Neurosyphilis[18][19] | + | ↑ Leukocytes and protein | CSF VDRL-specifc
CSF FTA-Ab -sensitive[20] |
+ | + | + | + | + | + | Unprotected sexual intercourse, STIs | Blindness, confusion, depression,
Abnormal gait | |||
| Viral encephalitis | + | Increased RBCS or xanthochromia, mononuclear lymphocytosis, high protein content, normal glucose | Clinical assesment | + | + | + | + | + | + | + | Tick bite/mosquito bite/ viral prodome for several days | Extreme lethargy, rash hepatosplenomegaly, lymphadenopathy, behavioral changes | ||
| Herpes simplex encephalitis | + | Clinical assesment | + | + | + | + | + | History of hypertension | Delirium, cortical blindness, cerebral edema, seizure | |||||
| Wernicke’s encephalopathy | Normal | + | + | + | History of alcohal abuse | Ophthalmoplegia, confusion | ||||||||
| CNS abscess | + | ↑ leukocytes >100,000/ul, ↓ glucose and ↑ protien, ↑ red blood cells, lactic acid >500mg | Contrast enhanced MRI is more sensitive and specific,
Histopathological examination of brain tissue |
+ | + | + | + | + | + | + | History of drug abuse, endocarditis, ↓ immune status | High grade fever, fatigue,nausea, vomiting | ||
| Drug toxicity | + | + | Lithium, Sedatives, phenytoin, carbamazepine | |||||||||||
| Conversion disorder | Diagnosis of exclusion | + | + | + | + | + | Tremors, blindness, difficulty swallowing | |||||||
| Electrolyte disturbance | ↓ or ↑ | Depends on the cause | + | + | Confusion, seizures | |||||||||
| Febrile seizures | Not performed in first simple febrile seizures | Clinical diagnosis and EEG | + | + | + | + | Family history of febrile seizures, viral illness or gastroenteritis | Age > 1 month, | ||||||
| Subdural empyema | + | Clinical assesment and MRI | + | + | + | + | + | + | History of relapses and remissions | Blurry vision, urinary incontinence, fatigue | ||||
| Hypoglycemia | ↓ or ↑ | Serum blood glucose | + | + | + | History of diabetes | Palpitations, sweating, dizziness, low serum, glucose | |||||||
Differentiating viral meningitis from other causes of meningitis
Bacterial meningitis may be differntiated from other causes of meningitis by cerebrospinal fluid examination:[21][22][23][24][25]
| Cerebrospinal fluid level | Normal level | Bacterial meningitis[24] | Viral meningitis[24] | Fungal meningitis | Tuberculous meningitis[26] | Malignant meningitis[21] |
|---|---|---|---|---|---|---|
| Cells/ul | < 5 | >300 | 10-1000 | 10-500 | 50-500 | >4 |
| Cells | Lymphos:Monos 7:3 | Gran. > Lymph | Lymph. > Gran. | Lympho.>Gran | Lymphocytes | Lymphocytes |
| Total protein (mg/dl) | 45-60 | Typically 100-500 | Normal or slightly high | High | Typically 100-200 | >50 |
| Glucose ratio (CSF/plasma)[22] | > 0.5 | < 0.3 | > 0.6 | <0.3 | < 0.5 | <0.5 |
| Lactate (mmols/l)[23] | < 2.1 | > 2.1 | < 2.1 | >3.2 | > 2.1 | >2.1 |
| Others | ICP:6-12 (cm H2O) | CSF gram stain, CSF culture, CSF bacterial antigen | PCR of HSV-DNA, VZV | CSF gram stain, CSF india ink | PCR of TBC-DNA | CSF tumour markers such as alpha fetoproteins, CEA |
References
- ↑ Stern TA, Celano CM, Gross AF, Huffman JC, Freudenreich O, Kontos N; et al. (2010). "The assessment and management of agitation and delirium in the general hospital". Prim Care Companion J Clin Psychiatry. 12 (1): PCC.09r00938. doi:10.4088/PCC.09r00938yel. PMC 2882819. PMID 20582303.
- ↑ 2.0 2.1 Soffer D (1976) Brain tumors simulating purulent meningitis. Eur Neurol 14 (3):192-7. PMID: 1278192
- ↑ 3.0 3.1 Terheggen HG (1985) [CNS tumors with the clinical picture of meningitis.] Monatsschr Kinderheilkd 133 (1):13-9. PMID: 3883130
- ↑ 4.0 4.1 Weston CL, Glantz MJ, Connor JR (2011). "Detection of cancer cells in the cerebrospinal fluid: current methods and future directions". Fluids Barriers CNS. 8 (1): 14. doi:10.1186/2045-8118-8-14. PMC 3059292. PMID 21371327.
- ↑ 5.0 5.1 Lee MC, Heaney LM, Jacobson RL, Klassen AC (1975). "Cerebrospinal fluid in cerebral hemorrhage and infarction". Stroke. 6 (6): 638–41. PMID 1198628.
- ↑ Han JH, Wilber ST (2013). "Altered mental status in older patients in the emergency department". Clin Geriatr Med. 29 (1): 101–36. doi:10.1016/j.cger.2012.09.005. PMC 3614410. PMID 23177603.
- ↑ 7.0 7.1 Birenbaum D, Bancroft LW, Felsberg GJ (2011). "Imaging in acute stroke". West J Emerg Med. 12 (1): 67–76. PMC 3088377. PMID 21694755.
- ↑ 8.0 8.1 DeLaPaz RL, Wippold FJ, Cornelius RS, Amin-Hanjani S, Angtuaco EJ, Broderick DF; et al. (2011). "ACR Appropriateness Criteria® on cerebrovascular disease". J Am Coll Radiol. 8 (8): 532–8. doi:10.1016/j.jacr.2011.05.010. PMID 21807345.
- ↑ Stein MT, Trauner D (1982). "The child with a stiff neck". Clin Pediatr (Phila). 21 (9): 559–63. PMID 7105615.
- ↑ De Cauwer HG, Eykens L, Hellinckx J, Mortelmans LJ (2007). "Differential diagnosis between viral and bacterial meningitis in children". Eur J Emerg Med. 14 (6): 343–7. doi:10.1097/MEJ.0b013e328270366b. PMID 17968200.
- ↑ Spanos A, Harrell FE, Durack DT (1989). "Differential diagnosis of acute meningitis. An analysis of the predictive value of initial observations". JAMA. 262 (19): 2700–7. PMID 2810603.
- ↑ Lindquist L, Linné T, Hansson LO, Kalin M, Axelsson G (1988). "Value of cerebrospinal fluid analysis in the differential diagnosis of meningitis: a study in 710 patients with suspected central nervous system infection". Eur J Clin Microbiol Infect Dis. 7 (3): 374–80. PMID 3137038.
- ↑ Naganuma M, Fujioka S, Inatomi Y, Yonehara T, Hashimoto Y, Hirano T; et al. (2008). "Clinical characteristics of subarachnoid hemorrhage with or without headache". J Stroke Cerebrovasc Dis. 17 (6): 334–9. doi:10.1016/j.jstrokecerebrovasdis.2008.04.009. PMID 18984423.
- ↑ Rajnik M, Ottolini MG (2000). "Serious infections of the central nervous system: encephalitis, meningitis, and brain abscess". Adolesc Med. 11 (2): 401–25. PMID 10916131.
- ↑ Tyler KL (2004). "Herpes simplex virus infections of the central nervous system: encephalitis and meningitis, including Mollaret's". Herpes. 11 Suppl 2: 57A–64A. PMID 15319091.
- ↑ Kennedy PG (2004). "Viral encephalitis: causes, differential diagnosis, and management". J Neurol Neurosurg Psychiatry. 75 Suppl 1: i10–5. PMC 1765650. PMID 14978145.
- ↑ Yeh ST, Lee WJ, Lin HJ, Chen CY, Te AL, Lin HJ (2003) Nonaneurysmal subarachnoid hemorrhage secondary to tuberculous meningitis: report of two cases. J Emerg Med 25 (3):265-70. PMID: 14585453
- ↑ 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.
- ↑ Berger JR, Dean D (2014). "Neurosyphilis". Handb Clin Neurol. 121: 1461–72. doi:10.1016/B978-0-7020-4088-7.00098-5. PMID 24365430.
- ↑ 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.
- ↑ 21.0 21.1 Le Rhun E, Taillibert S, Chamberlain MC (2013). "Carcinomatous meningitis: Leptomeningeal metastases in solid tumors". Surg Neurol Int. 4 (Suppl 4): S265–88. doi:10.4103/2152-7806.111304. PMC 3656567. PMID 23717798.
- ↑ 22.0 22.1 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.
- ↑ 23.0 23.1 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.
- ↑ 24.0 24.1 24.2 Negrini B, Kelleher KJ, Wald ER (2000). "Cerebrospinal fluid findings in aseptic versus bacterial meningitis". Pediatrics. 105 (2): 316–9. PMID 10654948.
- ↑ Brouwer MC, Tunkel AR, van de Beek D (2010). "Epidemiology, diagnosis, and antimicrobial treatment of acute bacterial meningitis". Clin Microbiol Rev. 23 (3): 467–92. doi:10.1128/CMR.00070-09. PMC 2901656. PMID 20610819.
- ↑ Caudie C, Tholance Y, Quadrio I, Peysson S (2010). "[Contribution of CSF analysis to diagnosis and follow-up of tuberculous meningitis]". Ann Biol Clin (Paris). 68 (1): 107–11. doi:10.1684/abc.2010.0407. PMID 20146981.