​Symptoms and Signs – Differential Diagnosis of Spinal Tumors
EXTRADURAL
• Metastases
• Primary bone tumors arising in spine
INTRADURAL EXTRAMEDULLARY
• Meningiomas
• Neurofibromas
• Schwannomas
• Lipomas
• Arachnoid cysts
• Epidermoid cysts
• Metastasis
INTRAMEDULLARY
• Ependymoma
• Glioma
• Hemangioblastoma
• Lipoma
• Metastases

​Symptoms and Signs – Differential Diagnosis of Spinocerebellar Ataxia
• Acquired vitamin E deficiency: differs from SCAs in that patients almost always have a clinically evident disorder of fat malabsorption.
• Creutzfeldt-Jakob disease: differs from the SCAs in that the ataxia progresses relatively rapidly and is accompanied by dementia and myoclonus.
• Mitochondrial encephalomyopathies
• Multiple sclerosis, other central nervous system inflammatory diseases: differ from SCAs in that ataxia, when present, usually presents acutely to subacutely.
• Multiple systems atrophy: differs from the SCAs in that age at onset n present.
• Paraneoplastic cerebellar degeneration: differs from SCAs in that the ataxia progresses relatively rapidly.
• Posterior fossa mass lesions
• Sensory ataxias: differ from the SCAs in that the primary defect is not one of cerebellar function but of sensory inputs into the cerebellum. They can be the result of peripheral neuropathies or spinal cord disease that involves the posterior columns.
• Superficial siderosis: differs from the SCAs in that it also often produces sensorineural hearing loss, anosmia, dementia, and bladder disturbance.
• Toxin exposure (alcohol, phenytoin, organic mercury)
• Wilson’s disease: differs from the SCAs in that there is often accompanying parkinsonism, psychiatric manifestations, and hepatic dysfunction.
is usually later and parkinsonism, long tract signs, and orthostatic hypotension are ofte• Friedreich’s ataxia: differs from the SCAs in that inheritance is autosomal recessive, it almost always begins in childhood or adolescence, and it is associated with early lower limb areflexia.

​Symptoms and Signs – Differential Diagnosis of Splenomegaly
• Bacterial infections: TB, infectious endocarditis, typhoid fever, splenic abscess
• Collagen-vascular disorders: systemic lupus erythematosus (SLE), rheumatoid arthritis (RA; Felty’s syndrome), polyarteritis nodosa
• Gaucher’s disease and other lipid storage diseases
• Hepatic cirrhosis
• Hereditary and acquired hemolytic anemias
• Idiopathic thrombocytopenic purpura (ITP)
• Neoplastic involvement: cell-mediated lympholysis (CML), chronic lymphocytic leukemia (CLL), lymphoma, multiple myeloma
• Parasitic infections (malaria, kala-azar, histoplasmosis)
• Polycythemia vera, myeloid metaplasia
• Sarcoidosis
• Serum sickness, drug hypersensitivity reaction
• Splenic cysts and benign tumors: hemangioma, lymphangioma
• Thrombosis of splenic or portal vein
• Viral infections: infectious mononucleosis, viral hepatitis, HIV infection

​Symptoms and Signs – Differential Diagnosis of Splenomegaly and Hepatomegaly
Causes of splenomegaly and hepatosplenomegaly:
MASSIVE SPLENOMEGALY
• Hematologic disease (e.g., chronic myeloid leukemia, myelofibrosis)
MODERATE SPLENOMEGALY
• The above causes
• Portal hypertension
• Hematologic disease (e.g., lymphoma, leukemia, thalassemia)
• Storage disease (e.g., Gaucher’s disease)
SMALL SPLENOMEGALY
• The above causes
• Infective (hepatitis, leptospirosis, malaria, bacterial endocarditis)
• Hematologic disease (e.g., hemolytic anemias, essential thrombocythemia, polycythemia rubra vera)
• Connective tissue diseases or vasculitis (e.g., rheumatoid arthritis, systemic lupus erythematosus, polyarteritis nodosa)
• Solitary cyst, polycystic syndrome, hydatid cyst
• Infiltration (amyloid, sarcoid)
HEPATOSPLENOMEGALY
• Chronic liver disease with portal hypertension
• Hematologic disease (e.g., myeloproliferative disease, lymphoma)
• Infection (e.g., acute viral hepatitis, infectious mononucleosis)
• Infiltration (e.g., amyloid, sarcoid)
• Connective tissue disease (e.g., systemic lupus erythematosus)

​Symptoms and Signs – Differential Diagnosis of Splenomegaly in Children
DISORDERS OF THE BLOOD
• Hemolytic anemia: congenital/acquired
• Thalassemia
• Sickle cell disease
• Leukemia
• Osteopetrosis
• Myelofibrosis, myeloid metaplasia, thrombocythemia
INFECTIONS: ACUTE AND CHRONIC
Viral
• Congenital (e.g., TORCH association)
• Mononucleosis (e.g., EBV, CMV infection)
• Virus-associated hemophagocytic syndrome
• Human immunodeficiency virus infection
Bacterial
• Sepsis/abscess
• Brucellosis
• Salmonellosis
• Tularemia
• Tuberculosis
• Subacute bacterial endocarditis
• Syphilis
• Lyme disease
Fungal
• Histoplasmosis (disseminated)
Rickettsia
• Rocky Mountain spotted fever
• Cat-scratch disease
Parasitic
• Toxoplasmosis
• Malaria
• Leishmaniasis (kala-azar)
• Schistosomiasis
• Echinococcosis
HEPATIC/PORTAL SYSTEM DISORDERS
• Acute/chronic active hepatitis
• Cirrhosis, hepatic fibrosis, biliary atresia
• Portal or splenic venous obstruction (Banti’s syndrome)
AUTOIMMUNE DISEASE
• Juvenile rheumatoid arthritis
• Systemic lupus erythematosus
• Autoimmune lymphoproliferative syndrome (Canale-Smith
syndrome)
NEOPLASMS/CYSTS
• Lymphomas (Hodgkin’s and non-Hodgkin’s)
• Hemangiomas/lymphangiomas
• Hamartomas
• Congenital or acquired (post-traumatic) cysts
STORAGE DISEASES/INBORN ERRORS OF METABOLISM
• Lipidoses: Gaucher’s disease, Niemann-Pick disease, others
• Mucopolysaccharidoses
• Defects in carbohydrate metabolism: galactosemia, fructose
intolerance
• Sea-blue histiocyte syndrome
MISCELLANEOUS DISORDERS
• Histiocytoses
• Reactive Langerhans cell
• Malignant sarcoidosis
• Congestive heart failure
• Familial Mediterranean fever

​Symptoms and Signs – Differential Diagnosis of Spontaneous Miscarriage
• Dysfunctional uterine bleeding
• Ectopic pregnancy
• Hydatidiform molar gestation
• Normal pregnancy
• Pathologic endometrial or cervical lesions

​Symptoms and Signs – Differential Diagnosis of Spinal Stenosis, Lumbar
• Acute cauda equina syndrome, resulting from compression by epidural abscess or tumors
• Intermittent claudication–peripheral vascular disease
• Osteoarthritis of the knee or hip
• Pain and weakness caused by multiple myeloma or osteomyelitis
• Peripheral neuropathy such as that caused by a herniated nucleus pulposus
• Rheumatoid diseases: ankylosing spondylitis, Reiter’s syndrome, fibromyalgia
• Scoliosis or spondylolisthesis

Symptoms and Sings - Differential Diagnosis of ​Somatization Disorder
• Conversion disorder: there is an alteration or loss of voluntary motor or sensory function with demonstrable physical cause and related to a psychological stress or a conflict. (NOTE: With multiple complaints, the diagnosis of conversion is not made.)
• Munchausen’s (factitious disorder) and malingering: the psychological basis of the complaints in somatization disorder is not conscious as in factitious disorder (Munchausen’s) and malingering, in which symptoms are produced intentionally.
• Pain disorder: distinguished from somatization disorder by the presence of other somatic complaints.
• Undifferentiated somatoform disorder: one or more physical complaints that cannot be explained by a medical condition are present for at least 6 months. (NOTE: Somatization is more severe and less common.)

​Symptoms and Signs – Differential Diagnosis of Smallpox
• Abdominal pain may mimic appendicitis.
• Dermatitis herpetiformis
• Impetigo
• Insect bites
• Meningococcemia
• Papular urticaria
• Pemphigus
• Rash from other viral illnesses (e.g., hemorrhagic chickenpox, measles, coxsackievirus)

​Symptoms and Signs – Differential Diagnosis of Smell Disturbance
• Dental caries, periodontal disease
• Exposure to noxious vapors
• Head trauma
• Idiopathic
• Medications
• Nasal or paranasal sinus disease
• Upper respiratory tract infection