Differential diagnosis

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Author:
cali-amber
ID:
95611
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Differential diagnosis
Updated:
2011-07-30 11:36:05
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clin path
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final review
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  1. presentation traumatic SCI
    • trauma
    • spinal shock
    • loss of sensation
    • loss motor fxn
    • altered DTRS (hypo at level of lesion)
    • spasticity
  2. presentation refute traumatic SCI
    • no trauma
    • no spinal shock
    • deficits at only 1 spinal level
    • cognitive deficit
    • CN involvement
  3. findings dx traumatic SCI
    MRI/CT
  4. presentation sc tumor
    • motor weakness- segmental level progressing to UMN
    • altered DTRs
    • sensory changes (tract or root)
    • increased ICP
    • B&B/ sexual dysfunction
  5. presentation refute sc tumor
    • trauma
    • cognitive changes
    • infection
    • degenerative conditions (bone and disc)
  6. findings dx sc tumor
    MRI, biopsy
  7. presentation ischemic CVA
    • rapid onset, slow onset
    • sudden weakness face, arm, leg
    • dizziness
    • sudden headache
    • loss of vision (1 eye)
    • BP
    • CN fxn
    • motor, sensory, reflexes altered
  8. risk factors ischemic CVA
    • HTN
    • diabetes
    • heart disease
    • high cholesterol
    • smoking, alcohol
    • obesity
    • >65
    • African American
    • males> females
    • family hx
    • prior hx
  9. presentation refute ischemic CVA
    • anti-coagulant therapy
    • onset during high activity level
    • CT: bleeding
  10. findings dx ischemic CVA
    MRI, neg CT, doppler US
  11. presentation subarachnoid hemorrhage
    • worst headache ever
    • neck stiffness
    • vomiting
    • convulsive seizures
    • sudden onset
  12. presentation refute subarachnoid hemorrhage
    • may/may not have trauma
    • progressive LOC
  13. findings dx subarachnoid hemorrhage
    • bleeding between pia and dura
    • need CT or arteriography
  14. presentation subdural hemorrhage
    • progressive LOC
    • tearing of perforating veins
    • slower onset
  15. presentation refute subdural hemorrhage
    rapid onset of sx
  16. findings dx subdural hemorrhage
    • CT
    • concave border
    • can cross suture lines
  17. presentation brain tumor
    • insidious onset
    • headeache (more w/ inc pressure such as when coughing)
    • personality changes
    • altered consciousness
    • focal neurological signs (CN lesions or parts of cortex compromised)
    • hx of cancer in other parts of body
    • vision changes
    • lethargy
    • seizures
  18. presentation refute brain tumor
    • systemic presentation, distal or prox muscles
    • onset after trauma
  19. findings dx brain tumor
    MRI or CT
  20. presentation TBI
    • trauma
    • unexplainable s/s (motor and sensory don't match up)
    • CN involvement
    • UMN signs
    • ICP increases
    • cognitive changes
    • pain w/ neck flexion
  21. presentation refute TBI
    • no trauma
    • LMN signs
    • specific distribution of involvement
  22. findings dx TBI
    • MRI
    • CT
    • lumbar puncture
  23. presentation MS
    • viral infection (autoimmune process)
    • vision problems
    • heat sensitivity
    • weakness
    • balance issues
    • UMN signs
    • spasticity
  24. presentation refute MS
    • sensory loss
    • non-progressive
    • no fatigue
    • heat doesn't inc s/s
    • CN deficits
    • LMN signs
    • no Lhermitte's sign
  25. findings dx MS
    • combination of presentation and imaging
    • 2+ lesions at different spaces or at different time
    • inc ICP
  26. presentation ALS
    • family hx
    • slurred speech
    • difficulty swallowing
    • weakness (esp hand intrinsics)
    • respiratory problems
    • asymmetrical
    • foot drop
    • UMN and LMN
    • distal to prox
  27. presentation refute ALS
    • UMN or LMN only
    • nerve root distribution
    • sudden onset
    • cognitive changes
  28. findings dx ALS
    • EMG (fibrillations)
    • R/O all other dxs
  29. presentation peripheral nerve entrapment
    • numbness, tingling, shooting pain
    • slower developing
    • lingering post trauma
    • asymmetrical
    • dermatome/myotome distribution
    • s/s provoked w/ neural tension tests
  30. presentation refute peripheral nerve entrapment
    • autoimmune
    • UMN signs
    • no mechanical interface
    • normal NCV
  31. findings dx peripheral nerve entrapment
    • inc s/s to sensitization w/ neural tension
    • dec MMT of peripheral nerve
    • hyporeflexia
    • NCV normal prox to interface and slowed distal to interface
  32. presentation Guillain-Barre
    • rapid progression
    • hx of recent illness
    • primarily motor issue
    • symmetrical
    • peripheral nervous system involvement
    • starts distal moves prox
  33. presentation refute Guillain-Barre
    • extraoccular eye involvement
    • prox s/s
    • UMN signs
  34. findings dx Gullain-Barre
    • clinical presentation
    • inc albumin in CSF
    • slow NCV
  35. presentation SMA
    • LMN signs (AHC)
    • prox weakness
    • atrophy of extremities
    • scoliosis
  36. presentation refute SMA
    • sensory involvement
    • no fibrosis or fat deposits
    • cognitive dysfunction
    • CN involvement
    • UMN signs
  37. findings dx SMA
    • normal NCV
    • EMG: fibrillations, fasciculations, sharp waves
    • muscle biopsy- atrophic amongst hypertrophic
    • genetic testing
  38. presentation post-polio
    • hx of polio
    • partial recovery in region of illness
    • fatigue
    • dec function
    • AHC involvement
    • weakness decades after illness
    • partial or complete recovery
    • fatigue
  39. presentation refute post-polio
    • no hx of polio
    • weakness outside original affected region
    • trauma to affected
    • infection
    • sensory deficits
    • UMN signs
  40. findings dx post-polio
    • EMG: denervation
    • hx of polio followed by partial or complete recovery and s/s return decades later
  41. presentation diabetic neuropathy
    • loss of sensation distally
    • sock and glove
    • distal mm weakness (esp LE)
    • LMN signs
    • proprioceptive loss
    • hx diabetes
  42. presentation refute diabetic neuropathy
    • no hx diabetes
    • prox s/s
    • UMN signs
  43. findings dx diabetic neuropathy
    • NCV
    • glucose test
  44. presentation myasthenia gravis
    • skeletal mm weakness
    • fatiguability
    • facial and ocular mm first
    • weak cervical mm
  45. presentation refute myasthenia gravis
    • distal mm weakness
    • no ocular involvement
    • sensory deficits
  46. findings dx myasthenia gravis
    • fatiguability reduced w/ rest
    • intact sensation
    • improved strength w/ ACH inhibitors
    • presence of ACH antibodies
    • dec motor AP
  47. presentation muscular dystrophy
    • Gower's sign
    • waddling gait
    • calf contractures
    • inc lordosis
    • prox muscles affected first
    • shoulder girdle weakness
  48. presentation refute MD
    • late onset
    • asymmetrical presentation
    • good LE strength
    • low NCV
    • no fibrillations
  49. findings dx MD
    • DNA testing
    • muscle biopsy
    • high creatine kinase levels

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