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Differential Diagnosis. Von and Eman. DIFFERENTIAL DIAGNOSIS. Meningitis Encephalitis Epilepsy Febrile seizures. MENINGITIS. Is an inflammation of the membranes ( meninges ) and cerebrospinal fluid surrounding the brain and spinal cord, usually due to the spread of an infection

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Differential Diagnosis

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Differential diagnosis

Differential Diagnosis

Von and Eman

Differential diagnosis1


  • Meningitis

  • Encephalitis

  • Epilepsy

  • Febrile seizures



  • Is an inflammation of the membranes (meninges) and cerebrospinal fluid surrounding the brain and spinal cord, usually due to the spread of an infection

  • The swelling associated with meningitis often triggers the "hallmark" symptoms of this condition, including headache, fever and a stiff neck

Differential diagnosis

  • Most cases of meningitis are caused by a viral infection, but bacterial and fungal infections also can lead to meningitis

    • Bacterial infections are the most damaging, identifying the source of the infection is an important part of developing a treatment plan

  • Depending on the cause of the infection, meningitis can resolve on its own in a couple of weeks — or it can be a life-threatening emergency

Differential diagnosis


    • Usually occurs when bacteria enter the bloodstream and migrate to the brain and spinal cord

    • Can directly invade the meninges, as a result of an ear or sinus infection or a skull fracture

Differential diagnosis

  • Streptococcus pneumoniae (pneumococcus)

    • Most common cause of bacterial meningitis in infants and young children in the United States.

  • Neisseriameningitidis (meningococcus)

    • Another leading cause of bacterial meningitis

    • It commonly occurs when bacteria from an upper respiratory infection enter your bloodstream.

    • Highly contagious and may cause local epidemics in college dormitories and boarding schools and on military bases

Differential diagnosis

  • Haemophilusinfluenzae (haemophilus)

    • Before the 1990s, Haemophilusinfluenzae type b (Hib) bacterium was the leading cause of bacterial meningitis.

    • Hib vaccines —routine childhood immunization

      • Greatly reduced the number of cases of this type of meningitis

    • It tends to follow an upper respiratory infection, ear infection (otitis media) or sinusitis

  • Listeriamonocytogenes (listeria)

    • These bacteria can be found almost anywhere — in soil, in dust and in foods that have become contaminated

      • Soft cheeses, hot dogs and luncheon meats

    • Most healthy people exposed to listeria don't become ill

      • Pregnant women, newborns and older adults tend to be more susceptible.

    • Listeria can cross the placental barrier, and infections in late pregnancy may cause a baby to be stillborn or die shortly after birth

Differential diagnosis

  • Viral meningitis

    • Usually mild and often clears on its own within two weeks

    • A group of common viruses known as enteroviruses are responsible for about 90 percent of viral meningitis in the United States

    • Most common signs and symptoms: Rash, sore throat, joint aches and headache

    • “Worst headache I've ever had“

  • Chronic meningitis

    • Ongoing (chronic) forms of meningitis occur when slow-growing organisms invade the membranes and fluid surrounding the brain

    • Although acute meningitis strikes suddenly, chronic meningitis develops over four weeks or more

    • Signs and symptoms: Headaches, fever, vomiting and mental cloudiness

    • This type of meningitis is rare

Differential diagnosis

  • Fungal meningitis

    • Relatively uncommon

    • Cryptococcal meningitis

      • Fungal form of the disease that affects people with immune deficiencies, such as AIDS

    • Life-threatening if not treated with an antifungal medication

  • Other meningitis causes

    • Meningitis can also result from noninfectious causes, such as drug allergies, some types of cancer and inflammatory diseases such as lupus

Differential diagnosis

Harrison’s Principles of Internal Medicine, 17th Edition



  • “Inflammation of the brain," it usually refers to brain inflammation resulting from a viral infection

    • Primary encephalitis

      • Involves direct viral infection of the brain and spinal cord

    • Secondary encephalitis

      • A viral infection first occurs elsewhere in the body and then travels to the brain

  • In contrast to viral meningitis, where the infectious process and associated inflammatory response are limited largely to the meninges, in encephalitis the brain parenchyma is also involved

Differential diagnosis

  • It can be caused by:

    • Bacterial infection

      • Spreads directly to the brain (primary encephalitis)

      • Bacterial meningitis

    • A complication of a current infectious disease

      • Syphilis (secondary encephalitis)

    • Parasitic or protozoal infestations

      • Can also cause encephalitis in people with compromised immune systems

      • Such as toxoplasmosis, malaria, or primary amoebic meningoencephalitis

    • Lyme disease and/or Bartonellahenselae may also cause encephalitis



  • Classified as a disorder of at least two unprovoked recurrent seizures

  • More common in young and old, plateau at 2nd– 4th decades of life

  • In children (0-14 years old)

    congenital> trauma=infection>CVA=tumor

Differential diagnosis

  • Genetic Predispostion

    • The direct result of a known or presumed genetic defect in which seizures are the core symptom of the disorder

      • Examples include childhood absence epilepsy, autosomal dominant nocturnal frontal lobe epilepsy, and Dravet syndrome

Differential diagnosis

  • Epileptic Seizures

    • No sexual predisposition, may occur at any age

    • Loss of consciousness is common

    • Onset is usually abrupt and may have a short aura

    • Vocalization is present during automatism

Dravet s syndrome

Dravet’s Syndrome

  • Severe myoclonic epilepsy of infancy (SMEI)

  • Generalized epilepsy syndrome

  • Onset is in the first year of life

  • Peaks at about 5 months of age with febrile hemiclonic or generalized status epilepticus

  • Boys are twice as often affected as girls

  • Prognosis is poor

Differential diagnosis

  • Most cases are sporadic

  • Family history of epilepsy and febrile convulsions is present in around 25 percent of the cases

  • Known causative genes are the sodium channel α subunit genes SCN1A and SCN2A, an associated β subunit SCN1B, and a GABAA receptor γ subunit gene, GABRG2



Febrile seizures


  • Fever fit or febrile convulsion, is a convulsion triggered by a rise in body temperature

  • The direct cause of a febrile seizure is not known

    • It is normally precipitated by a recent upper respiratory infection or gastroenteritis

  • A febrile seizure is the effect of a sudden rise in temperature (>39°C/102°F) rather than a fever that has been present for a prolonged length of time

Differential diagnosis

  • Simple febrile seizure

    • Seizure lasts less than 15 minutes, does not recur in 24 hours, and involves the entire body (classically a generalized tonic-clonicseizure)

  • Complex febrile seizure

    • Characterized by longer duration, recurrence, or focus on only part of the body

Differential diagnosis

  • The simple seizure represents the majority of cases and is considered to be less of a cause for concern than the complex

    • Simple febrile seizures generally do not cause permanent brain injury

    • Prognosis after a simple febrile seizure is excellent, whereas an increased risk of death has been shown for complex febrile seizures, partly related to underlying conditions



  • Harrison’s Principle of Internal Medicine, 17th edition

  • http://www.ilae-epilepsy.org/Visitors/About_ILAE/Index.cfm

  • http://www3.interscience.wiley.com/journal/118734154/abstract

  • http://www.ninds.nih.gov/disorders/epilepsy/epilepsy.htm

  • http://www.epilepsyfoundation.org/about/types/causes/genetics.cfm

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