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Symptoms and Signs – Differential Diagnosis of Pericarditis
• Pulmonary infarction
• Pneumothorax
• Pneumonia with pleurisy
• Hepatitis
• GI abnormalities (e.g., hiatal hernia, esophageal rupture)
• Dissecting aneurysm
• Cholecystitis
• Angina pectoris
• Pulmonary infarction
• Pneumothorax
• Pneumonia with pleurisy
• Hepatitis
• GI abnormalities (e.g., hiatal hernia, esophageal rupture)
• Dissecting aneurysm
• Cholecystitis
• Angina pectoris
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Symptoms and Signs – Differential Diagnosis of Hyperkalemic Periodic Paralysis
• Renal insufficiency with excessive potassium supplementation
• Potassium-sparing diuretics
• Endocrinopathies (hypoaldosteronism, adrenal insufficiency)
• Chronic renal failure
• Renal insufficiency with excessive potassium supplementation
• Potassium-sparing diuretics
• Endocrinopathies (hypoaldosteronism, adrenal insufficiency)
• Chronic renal failure
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Symptoms and Signs – Differential Diagnosis of Hypokalemic Periodic Paralysis
• Thyrotoxicosis
• Renal tubular acidosis
• Potassium-depleting diuretics
• Medications (amphotericin B, corticosteroids)
• Conn’s syndrome
• Chronic licorice ingestion
• Chronic diarrhea (laxative abuse, sprue, villous adenoma)
• Bartter’s syndrome
• Barium intoxication
• Thyrotoxicosis
• Renal tubular acidosis
• Potassium-depleting diuretics
• Medications (amphotericin B, corticosteroids)
• Conn’s syndrome
• Chronic licorice ingestion
• Chronic diarrhea (laxative abuse, sprue, villous adenoma)
• Bartter’s syndrome
• Barium intoxication
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Symptoms and Signs – Differential Diagnosis of Peripheral Arterial Disease
• Spinal stenosis
• Muscle cramps
• Degenerative joint disease of the lumbar spine and hips
• Compartment syndrome
• Spinal stenosis
• Muscle cramps
• Degenerative joint disease of the lumbar spine and hips
• Compartment syndrome
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Symptoms and Signs – Differential Diagnosis of Peritoneal Carcinomatosis
• Stomach
• Pseudomyxoma peritonei
• Primary disorders of the peritoneum: mesothelioma
• Pancreas
• Ovary
• Other intra-abdominal organs
• Metastatic spread from
• Lymphoma
• Lung
• Hematologic malignant neoplasm
• Extra-abdominal primary tumors
• Colon
• Carcinoid
• Breast
• Stomach
• Pseudomyxoma peritonei
• Primary disorders of the peritoneum: mesothelioma
• Pancreas
• Ovary
• Other intra-abdominal organs
• Metastatic spread from
• Lymphoma
• Lung
• Hematologic malignant neoplasm
• Extra-abdominal primary tumors
• Colon
• Carcinoid
• Breast
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Symptoms and Signs – Differential Diagnosis of Non Endocrine Paraneoplastic Syndromes
CUTANEOUS
• Dermatomyositis
• Acanthosis nigricans
• Sweet’s syndrome
• Erythema gyratum repens
• Systemic nodular panniculitis (Weber-Christian disease)
RENAL
• Nephrotic syndrome
• Nephrogenic diabetes insipidus
NEUROLOGIC
• Subacute cerebellar degeneration
• Progressive multifocal leukoencephalopathy
• Subacute motor neuropathy
• Sensory neuropathy
• Ascending acute polyneuropathy (Guillain-Barré syndrome)
• Myasthenic syndrome (Eaton-Lambert syndrome)
HEMATOLOGIC
• Microangiopathic hemolytic anemia
• Migratory thrombophlebitis (Trousseau’s syndrome)
• Anemia of chronic disease
RHEUMATOLOGIC
• Polymyalgia rheumatica
• Hypertrophic pulmonary osteoarthropathy
CUTANEOUS
• Dermatomyositis
• Acanthosis nigricans
• Sweet’s syndrome
• Erythema gyratum repens
• Systemic nodular panniculitis (Weber-Christian disease)
RENAL
• Nephrotic syndrome
• Nephrogenic diabetes insipidus
NEUROLOGIC
• Subacute cerebellar degeneration
• Progressive multifocal leukoencephalopathy
• Subacute motor neuropathy
• Sensory neuropathy
• Ascending acute polyneuropathy (Guillain-Barré syndrome)
• Myasthenic syndrome (Eaton-Lambert syndrome)
HEMATOLOGIC
• Microangiopathic hemolytic anemia
• Migratory thrombophlebitis (Trousseau’s syndrome)
• Anemia of chronic disease
RHEUMATOLOGIC
• Polymyalgia rheumatica
• Hypertrophic pulmonary osteoarthropathy
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Symptoms and Signs – Differential Diagnosis of Paranoid Personality Disorder
• Schizophrenia (paranoid type), delusional disorder (paranoid type), and mood disorder with psychotic symptoms: require presence of persistent positive psychotic symptoms such as delusions and hallucinations. To give an additional diagnosis of paranoid personality disorder (PPD), the personality disorder must be present before the onset of psychotic symptoms and must persist when the psychotic symptoms are in remission.
• Substance-induced paranoia, especially in the context of cocaine or methamphetamine abuse or dependence
• Personality changes due to a general medical condition that affects the central nervous system
• Paranoid traits associated with a sensory disability, for example, hearing impairment
• The most common co-occurring personality disorders are schizotypal, schizoid, narcissistic, avoidant, and borderline:
• Schizotypal personality disorder includes magical thinking and
unusual perceptual experiences.
• Schizoid and borderline personality disorders do not have
prominent paranoid ideation.
• Avoidant personality disorder includes fear of embarrassment.
• Narcissistic personality disorder includes the fear that hidden
“flaws” or “inferiority” may be revealed.
• Schizophrenia (paranoid type), delusional disorder (paranoid type), and mood disorder with psychotic symptoms: require presence of persistent positive psychotic symptoms such as delusions and hallucinations. To give an additional diagnosis of paranoid personality disorder (PPD), the personality disorder must be present before the onset of psychotic symptoms and must persist when the psychotic symptoms are in remission.
• Substance-induced paranoia, especially in the context of cocaine or methamphetamine abuse or dependence
• Personality changes due to a general medical condition that affects the central nervous system
• Paranoid traits associated with a sensory disability, for example, hearing impairment
• The most common co-occurring personality disorders are schizotypal, schizoid, narcissistic, avoidant, and borderline:
• Schizotypal personality disorder includes magical thinking and
unusual perceptual experiences.
• Schizoid and borderline personality disorders do not have
prominent paranoid ideation.
• Avoidant personality disorder includes fear of embarrassment.
• Narcissistic personality disorder includes the fear that hidden
“flaws” or “inferiority” may be revealed.
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Symptoms and Signs – Differential Diagnosis of Paraplegia
• Trauma: penetrating wounds to motor cortex, fracture-dislocation of vertebral column with compression of spinal cord or cauda equina, prolapsed disk, electrical injuries
• Thrombosis of superior sagittal sinus
• Polyneuritis: Guillain-Barré syndrome, diabetes, alcohol, beriberi,
• Neoplasm: parasagittal region, vertebrae, meninges, spinal cord, cauda equina; Hodgkin’s disease, non-Hodgkin’s lymphoma (NHL), leukemic deposits, pelvic neoplasms
• Multiple sclerosis (MS) and other demyelinating disorders
• Mechanical compression of spinal cord, cauda equina, or lumbosacral plexus: Paget’s disease, kyphoscoliosis, herniation of intervertebral disk, spondylosis, ankylosing spondylitis, rheumatoid arthritis (RA), aortic aneurysm
• Infections: spinal abscess, syphilis, TB, poliomyelitis, leprosy
• Heredofamilial muscular dystrophies
• Amyotrophic lateral sclerosis (ALS)
• Congenital and familial conditions: syringomyelia, myelomeningocele, myelodysplasia
• Hysteria and heavy metals.
• Trauma: penetrating wounds to motor cortex, fracture-dislocation of vertebral column with compression of spinal cord or cauda equina, prolapsed disk, electrical injuries
• Thrombosis of superior sagittal sinus
• Polyneuritis: Guillain-Barré syndrome, diabetes, alcohol, beriberi,
• Neoplasm: parasagittal region, vertebrae, meninges, spinal cord, cauda equina; Hodgkin’s disease, non-Hodgkin’s lymphoma (NHL), leukemic deposits, pelvic neoplasms
• Multiple sclerosis (MS) and other demyelinating disorders
• Mechanical compression of spinal cord, cauda equina, or lumbosacral plexus: Paget’s disease, kyphoscoliosis, herniation of intervertebral disk, spondylosis, ankylosing spondylitis, rheumatoid arthritis (RA), aortic aneurysm
• Infections: spinal abscess, syphilis, TB, poliomyelitis, leprosy
• Heredofamilial muscular dystrophies
• Amyotrophic lateral sclerosis (ALS)
• Congenital and familial conditions: syringomyelia, myelomeningocele, myelodysplasia
• Hysteria and heavy metals.
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Symptoms and Signs – Differential Diagnosis of Paresthesias
• Toxic chemicals (e.g., lead, arsenic, cyanide, mercury, organophosphates)
• Sarcoidosis
• Nutritional deficiencies (thiamine, vitamin B12, folic acid)
• Neoplasms
• Myxedema
• Multiple sclerosis (MS)
• Medications (e.g., isonicotinic acid hydrazide [INH], lithium, nitrofurantoin, gold, cisplatin, hydralazine, amitriptyline, sulfonamides, amiodarone, metronidazole, dapsone, disulfiram, chloramphenicol)
• Infections (HIV, Lyme disease, herpes zoster, leprosy, diphtheria)
• Guillain-Barré neuropathy
• Diabetes mellitus (DM)
• Compression of spinal cord or peripheral nerves
• Charcot-Marie-Tooth syndrome and other hereditary neuropathies
• Alcohol
• Toxic chemicals (e.g., lead, arsenic, cyanide, mercury, organophosphates)
• Sarcoidosis
• Nutritional deficiencies (thiamine, vitamin B12, folic acid)
• Neoplasms
• Myxedema
• Multiple sclerosis (MS)
• Medications (e.g., isonicotinic acid hydrazide [INH], lithium, nitrofurantoin, gold, cisplatin, hydralazine, amitriptyline, sulfonamides, amiodarone, metronidazole, dapsone, disulfiram, chloramphenicol)
• Infections (HIV, Lyme disease, herpes zoster, leprosy, diphtheria)
• Guillain-Barré neuropathy
• Diabetes mellitus (DM)
• Compression of spinal cord or peripheral nerves
• Charcot-Marie-Tooth syndrome and other hereditary neuropathies
• Alcohol
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Symptoms and Signs – Differential Diagnosis of Parkinson’s Disease
• Toxins (e.g., 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine [MPTP], manganese, carbon monoxide)
• Secondary (acquired) parkinsonism
• Progressive supranuclear palsy: tends to have axial rigidity greater than appendicular (limb) rigidity. These patients have early and severe postural instability. Hallmark is supranuclear gaze palsy that usually involves vertical gaze before horizontal.
• Postinfectious parkinsonism: von Economo’s encephalitis
• Parkinson’s pugilistica: after repeated head trauma
• Multisystem atrophy: distinguishing features of autonomic dysfunction, including urinary incontinence, orthostatic hypotension, and erectile dysfunction; parkinsonism, cerebellar signs, and normal cognition
• Iatrogenic: any of the neuroleptics and antipsychotics. The high potency D2 blocker neuroleptics are most likely to cause parkinsonism.
• Essential tremor
• Diffuse Lewy body disease: parkinsonism with concomitant dementia. Patients often have early hallucinations and fluctuations in level of alertness and mental status.
• Corticobasal degeneration: often begins asymmetrically with apraxia, cortical sensory loss in one limb, and sometimes alien limb phenomenon
• Cerebrovascular disease (basal ganglia infarcts)
• Toxins (e.g., 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine [MPTP], manganese, carbon monoxide)
• Secondary (acquired) parkinsonism
• Progressive supranuclear palsy: tends to have axial rigidity greater than appendicular (limb) rigidity. These patients have early and severe postural instability. Hallmark is supranuclear gaze palsy that usually involves vertical gaze before horizontal.
• Postinfectious parkinsonism: von Economo’s encephalitis
• Parkinson’s pugilistica: after repeated head trauma
• Multisystem atrophy: distinguishing features of autonomic dysfunction, including urinary incontinence, orthostatic hypotension, and erectile dysfunction; parkinsonism, cerebellar signs, and normal cognition
• Iatrogenic: any of the neuroleptics and antipsychotics. The high potency D2 blocker neuroleptics are most likely to cause parkinsonism.
• Essential tremor
• Diffuse Lewy body disease: parkinsonism with concomitant dementia. Patients often have early hallucinations and fluctuations in level of alertness and mental status.
• Corticobasal degeneration: often begins asymmetrically with apraxia, cortical sensory loss in one limb, and sometimes alien limb phenomenon
• Cerebrovascular disease (basal ganglia infarcts)
