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Symptoms and Signs - Differential Diagnosis of Ataxia
• Wilson’s disease (hepatolenticular degeneration)
• Vitamin B12 deficiency
• Vertebral-basilar artery ischemia
• Toxins: phenytoin, alcohol, sedatives, organophosphates
• Tabes dorsalis
• Paraneoplastic syndromes
• Parainfectious: Guillain-Barré syndrome, acute ataxia of childhood and young adults
• Nutritional (Wernicke’s encephalopathy)
• Myopathy
• Multiple sclerosis and other demyelinating diseases
• Meningomyelopathy
• Labyrinthine destruction: neoplasm, injury, inflammation, compression
• Hysteria
• Hypothyroidism
• Frontal lobe lesions: tumors, thrombosis of anterior cerebral artery, hydrocephalus
• Diabetic neuropathy
• Cerebellar neoplasms, hemorrhage, abscess, infarct
• Cerebellar and spinocerebellar degeneration: ataxia-telangiectasia, Friedreich’s ataxia
• AIDS
• Wilson’s disease (hepatolenticular degeneration)
• Vitamin B12 deficiency
• Vertebral-basilar artery ischemia
• Toxins: phenytoin, alcohol, sedatives, organophosphates
• Tabes dorsalis
• Paraneoplastic syndromes
• Parainfectious: Guillain-Barré syndrome, acute ataxia of childhood and young adults
• Nutritional (Wernicke’s encephalopathy)
• Myopathy
• Multiple sclerosis and other demyelinating diseases
• Meningomyelopathy
• Labyrinthine destruction: neoplasm, injury, inflammation, compression
• Hysteria
• Hypothyroidism
• Frontal lobe lesions: tumors, thrombosis of anterior cerebral artery, hydrocephalus
• Diabetic neuropathy
• Cerebellar neoplasms, hemorrhage, abscess, infarct
• Cerebellar and spinocerebellar degeneration: ataxia-telangiectasia, Friedreich’s ataxia
• AIDS
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Symptoms and Signs - Differential Diagnosis of Acute or Recurrent Ataxia
• Vascular events (e.g., cerebellar hemorrhage or stroke)
• Seizure (ictal or postictal)
• Postinfectious (cerebellitis [e.g., varicella], acute disseminated encephalomyelitis)
• Multiple sclerosis
• Miller-Fisher variant of Guillain-Barré syndrome (ataxia, ophthalmoplegia, and areflexia). WARNING: If bulbar signs are present, disease is likely progressive; patient may lose ability to protect airway or ability to breathe.
• Inherited ataxias
• Infection (e.g., labyrinthitis, abscess)
• Inborn errors of metabolism (e.g., mitochondrial disorders,aminoacidopathies, urea cycle defects)
• Hydrocephalus
• Head trauma
• Drug ingestion (e.g., phenytoin, carbamazepine, sedatives, hypnotics, and phencyclidine) or intoxication (e.g., alcohol, ethylene glycol, hydrocarbon fumes, lead, mercury, or thallium)
• Conversion reaction
• Brain tumor or neuroblastoma (if accompanied by opsoclonus or myoclonus [i.e., “dancing eyes, dancing feet”])
• Benign paroxysmal vertigo (migraine equivalent)
• Basilar migraine
• Vascular events (e.g., cerebellar hemorrhage or stroke)
• Seizure (ictal or postictal)
• Postinfectious (cerebellitis [e.g., varicella], acute disseminated encephalomyelitis)
• Multiple sclerosis
• Miller-Fisher variant of Guillain-Barré syndrome (ataxia, ophthalmoplegia, and areflexia). WARNING: If bulbar signs are present, disease is likely progressive; patient may lose ability to protect airway or ability to breathe.
• Inherited ataxias
• Infection (e.g., labyrinthitis, abscess)
• Inborn errors of metabolism (e.g., mitochondrial disorders,aminoacidopathies, urea cycle defects)
• Hydrocephalus
• Head trauma
• Drug ingestion (e.g., phenytoin, carbamazepine, sedatives, hypnotics, and phencyclidine) or intoxication (e.g., alcohol, ethylene glycol, hydrocarbon fumes, lead, mercury, or thallium)
• Conversion reaction
• Brain tumor or neuroblastoma (if accompanied by opsoclonus or myoclonus [i.e., “dancing eyes, dancing feet”])
• Benign paroxysmal vertigo (migraine equivalent)
• Basilar migraine
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Symptoms and Signs - Differential Diagnosis of Chronic or Progressive Ataxia
• Wilson’s disease
• Tumor or paraneoplastic syndrome
• Low vitamin E levels (e.g., cystic fibrosis)
• Inherited ataxias (e.g., ataxia-telangiectasia, Friedreich’s ataxia)
• Inborn errors of metabolism
• Hypothyroidism
• Hydrocephalus
• Wilson’s disease
• Tumor or paraneoplastic syndrome
• Low vitamin E levels (e.g., cystic fibrosis)
• Inherited ataxias (e.g., ataxia-telangiectasia, Friedreich’s ataxia)
• Inborn errors of metabolism
• Hypothyroidism
• Hydrocephalus
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Symptoms and Sign - Differential Diagnosis of Ataxia-Telangiectasia
• Friedreich’s ataxia
• Early-onset cerebellar ataxia with retained reflexes (EOCA)
• Ataxia associated with biochemical abnormalities: associated with ceroid lipofuscinosis, xeroderma pigmentosa, Cockayne’s syndrome, adrenoleukodystrophy, metachromatic leukodystrophy, mitochondrial disease, sialidosis, Niemann-Pick disease
• Acquired vitamin E deficiency
• Abetalipoproteinemia (Bassen-Kornzweig syndrome)
• Friedreich’s ataxia
• Early-onset cerebellar ataxia with retained reflexes (EOCA)
• Ataxia associated with biochemical abnormalities: associated with ceroid lipofuscinosis, xeroderma pigmentosa, Cockayne’s syndrome, adrenoleukodystrophy, metachromatic leukodystrophy, mitochondrial disease, sialidosis, Niemann-Pick disease
• Acquired vitamin E deficiency
• Abetalipoproteinemia (Bassen-Kornzweig syndrome)
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Symptoms and Signs - Differential Diagnosis of Atelectasis
• Sarcoidosis
• Postoperative (lower lobes)
• Postinflammatory (middle lobe syndrome)
• Pneumothorax
• Pneumoconiosis
• Pleural effusion
• Mucoid impaction
• Mediastinal or adjacent mass
• Lung neoplasm (primary or metastatic)
• Interstitial fibrosis
• Infection (pneumonia, TB, fungal, histoplasmosis)
• Foreign body
• Bulla
• Sarcoidosis
• Postoperative (lower lobes)
• Postinflammatory (middle lobe syndrome)
• Pneumothorax
• Pneumoconiosis
• Pleural effusion
• Mucoid impaction
• Mediastinal or adjacent mass
• Lung neoplasm (primary or metastatic)
• Interstitial fibrosis
• Infection (pneumonia, TB, fungal, histoplasmosis)
• Foreign body
• Bulla
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Symptoms and Signs -Differential Diagnosis of Atrial Fibrillation
• Multifocal atrial tachycardia
• Frequent atrial premature beats
• Baseline ECG artifact
• Atrial flutter
• Multifocal atrial tachycardia
• Frequent atrial premature beats
• Baseline ECG artifact
• Atrial flutter
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Symptoms and Signs - Differential Diagnosis of Atrial Flutter
• Paroxysmal atrial tachycardia
• ECG baseline artifact
• Atrial fibrillation
• Atrial ectopy
• Paroxysmal atrial tachycardia
• ECG baseline artifact
• Atrial fibrillation
• Atrial ectopy
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Symptoms and Signs - Differential Diagnosis of Atrial Myxoma
• Vasculitis
• Tricuspid stenosis
• Tricuspid regurgitation
• Pulmonary hypertension
• Pulmonary embolism
• Mitral stenosis
• Mitral regurgitation
• Left atrial thrombus
• Endocarditis
• Ebstein’s anomaly
• Collagen-vascular disease
• Cerebrovascular accidents
• Carcinoid heart disease
• Vasculitis
• Tricuspid stenosis
• Tricuspid regurgitation
• Pulmonary hypertension
• Pulmonary embolism
• Mitral stenosis
• Mitral regurgitation
• Left atrial thrombus
• Endocarditis
• Ebstein’s anomaly
• Collagen-vascular disease
• Cerebrovascular accidents
• Carcinoid heart disease
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Symptoms and Signs - Differential Diagnosis of Atrial Septal Defect (ASD)
• Rheumatic heart disease
• Pulmonary stenosis
• Primary pulmonary hypertension
• Mitral valve prolapse
• Cor pulmonale
• Rheumatic heart disease
• Pulmonary stenosis
• Primary pulmonary hypertension
• Mitral valve prolapse
• Cor pulmonale
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Symptoms and Signs - Differential Diagnosis of Atrioventricular Nodal Block
• Trauma (including cardiac surgical procedures)
• Sclerodegenerative processes (e.g., Lev’s disease with calcification of the mitral and aortic annuli)
• Myocarditis
• Medications (e.g., digoxin, b-blockers, calcium channel blockers, class III antiarrhythmics)
• Infiltrative diseases (e.g., hemochromatosis, sarcoidosis, amyloidosis)
• Infections (endocarditis, Lyme disease)
• Idiopathic fibrosis (Lenègre’s disease)
• Electrolyte abnormalities (e.g., hyperkalemia)
• Collagen-vascular diseases
• AV node radiofrequency ablation procedure
• Aortic root diseases (e.g., spondylitis)
• Acute inferior wall myocardial infarction (MI)
• Trauma (including cardiac surgical procedures)
• Sclerodegenerative processes (e.g., Lev’s disease with calcification of the mitral and aortic annuli)
• Myocarditis
• Medications (e.g., digoxin, b-blockers, calcium channel blockers, class III antiarrhythmics)
• Infiltrative diseases (e.g., hemochromatosis, sarcoidosis, amyloidosis)
• Infections (endocarditis, Lyme disease)
• Idiopathic fibrosis (Lenègre’s disease)
• Electrolyte abnormalities (e.g., hyperkalemia)
• Collagen-vascular diseases
• AV node radiofrequency ablation procedure
• Aortic root diseases (e.g., spondylitis)
• Acute inferior wall myocardial infarction (MI)
