Viral encephalitis differential diagnosis

Viral encephalitis Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Viral Encephalitis from Other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

MRI

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Viral encephalitis differential diagnosis On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Viral encephalitis differential diagnosis

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Viral encephalitis differential diagnosis

CDC on Viral encephalitis differential diagnosis

Viral encephalitis differential diagnosis in the news

Blogs on Viral encephalitis differential diagnosis

Directions to Hospitals Treating Encephalitis

Risk calculators and risk factors for Viral encephalitis differential diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:  Priyamvada Singh, MBBS [2]; Anthony Gallo, B.S. [3]

## Overview[edit | edit source]

Encephalitis must be differentiated from other neurologic diseases such as brain abscess, meningitis, status epilepticus, and subarachnoid hemorrhage.

## Differential Diagnosis[edit | edit source]

### Complete Differential Diagnosis of the Causes of Encephalitis[edit | edit source]

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[1][2] |  | ✔  | Cancer cells[3] | MRI  |  | ✔  | ✔  | ✔  | ✔  | ✔  |  | ✔  |  | Cachexia, gradual progression of symptoms
Delirium tremens |  | ✔  |  | Clinical diagnosis  |  | ✔  | ✔  |  | ✔  | ✔  | ✔  | ✔  | Alcohol intake, sudden witdrawl or reduction in consumption  | Tachycardia, diaphoresis, hypertension, tremors, mydriasis, positional nystagmus,
Subarachnoid hemorrhage[4] |  | ✔  | Xanthochromia[5] | CT scan without contrast[6][7] | ✔  | ✔  | ✔  | ✔  | ✔  | ✔  | ✔  | ✔  | Trauma/fall  | Confusion, dizziness, nausea, vomiting
Stroke |  | ✔  | Normal  | CT scan without contrast  |  | ✔  | ✔  |  | ✔  | ✔  |  | ✔  | TIAs, hypertension, diabetes mellitus | Speech difficulty, gait abnormality
Neurosyphilis[8][9] |  | ✔  | ↑ Leukocytes and protein | CSF VDRL-specifc

CSF FTA-Ab -sensitive[10]

| ✔  | ✔  | ✔  | ✔  |  | ✔  |  | ✔  | 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, behavioural 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 convulsion |  |  | 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

HbA1c

|  | ✔  |  |  |  | ✔  |  | ✔  | History of diabetes | Palpitations, sweating, dizziness, low serum, glucose

(By organ system)

Cardiovascular | No underlying causes

|

Chemical / poisoning | No underlying causes
Dermatologic | No underlying causes
Drug Side Effect | No underlying causes
Ear Nose Throat | No underlying causes
Endocrine | No underlying causes
Environmental | No underlying causes
Gastroenterologic | No underlying causes
Genetic | No underlying causes
Hematologic | No underlying causes
Iatrogenic | No underlying causes
Infectious Disease | Herpes Simplex, Cat Scratch Disease, Leptospirosis, Tick-borne diseases, Rocky Mountain Spotted Fever, Toxoplasmosis
Musculoskeletal / Ortho | No underlying causes
Neurologic | Brain Abscess, Herpes Simplex Encephalitis, Meningitis, Status epilepticus, Subarachnoid hemorrhage
Nutritional / Metabolic | Hypoglycemia
Obstetric/Gynecologic | No underlying causes
Oncologic | No underlying causes
Opthalmologic | No underlying causes
Overdose / Toxicity | No underlying causes
Psychiatric | No underlying causes
Pulmonary | Tuberculosis
Renal / Electrolyte | No underlying causes
Rheum / Immune / Allergy | Systemic Lupus Erythematosus
Sexual | No underlying causes
Trauma | No underlying causes
Urologic | No underlying causes
Miscellaneous | No underlying causes

## References[edit | edit source]

1. ↑ Soffer D (1976) Brain tumors simulating purulent meningitis. Eur Neurol 14 (3):192-7. PMID: 1278192
2. ↑ Invalid `<ref>` tag; no text was provided for refs named `pmid3883130`
3. ↑ 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.CS1 maint: Multiple names: authors list (link)
4. ↑ 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
5. ↑ Lee MC, Heaney LM, Jacobson RL, Klassen AC (1975). "Cerebrospinal fluid in cerebral hemorrhage and infarction". Stroke. 6 (6): 638–41. PMID 1198628.CS1 maint: Multiple names: authors list (link)
6. ↑ Birenbaum D, Bancroft LW, Felsberg GJ (2011). "Imaging in acute stroke". West J Emerg Med. 12 (1): 67–76. PMC 3088377. PMID 21694755.CS1 maint: Multiple names: authors list (link)
7. ↑ 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.CS1 maint: Explicit use of et al. (link) CS1 maint: Multiple names: authors list (link)
8. ↑ 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.CS1 maint: Explicit use of et al. (link) CS1 maint: Multiple names: authors list (link)
9. ↑ Berger JR, Dean D (2014). "Neurosyphilis". Handb Clin Neurol. 121: 1461–72. doi:10.1016/B978-0-7020-4088-7.00098-5. PMID 24365430.
10. ↑ 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.

Template:WikiDoc Sources