Differentials
Central nervous system tuberculoma
SIGNS / SYMPTOMS
Patients are normally febrile.
There may also be signs of tuberculosis elsewhere (e.g., chronic cough, hemoptysis, bone pain).
INVESTIGATIONS
Tuberculin skin test: positive.
Interferon-gamma release assay: positive.
Other investigations depend on clinical presentation.
Amebic abscess
SIGNS / SYMPTOMS
Patients are normally febrile.
INVESTIGATIONS
Stool antigen detection or polymerase chain reaction: positive for Entamoeba antigens or RNA.
Serology: positive for antiamebic antibodies.
Erythrocyte sedimentation rate: elevated.
Migraine
SIGNS / SYMPTOMS
Patients usually have unilateral motor or sensory signs and headache.
INVESTIGATIONS
Diagnosis is based on history and physical exam.
Stool exam and serology for tapeworm species: negative.
Epilepsy
SIGNS / SYMPTOMS
Patients usually experience premonitory sensations (fear, epigastric sensation, déjà vu, jamais vu).
INVESTIGATIONS
EEG: normal.
CT/MRI head: may show structural lesion.
Gastroenteritis
SIGNS / SYMPTOMS
Patients may be febrile with associated vomiting and watery diarrhea.
INVESTIGATIONS
Diagnosis is based on history and physical exam.
Stool exam and serology for tapeworm species: negative.
Brain tumor
SIGNS / SYMPTOMS
Patients have focal neurologic deficits according to location.
INVESTIGATIONS
CT/MRI head: area of hypointensity on T1 sequences and hyperintensity on T2 sequences; specific findings depend on location.
Liver metastases
SIGNS / SYMPTOMS
Patients may be jaundiced with ascites and a history of cancer.
INVESTIGATIONS
LFTs: abnormal.
Ultrasound liver: poorly defined margins and coarse, irregular echoes.
CT/MRI abdomen: typical hypervascular pattern; vascular lesions; dysplastic nodules.
Cholecystitis
SIGNS / SYMPTOMS
Patients may have positive Murphy sign with right shoulder pain. May have fever or abdominal mass.
INVESTIGATIONS
LFTs: abnormal.
CBC: elevated WBC.
Ultrasound abdomen: pericholecystic fluid; distended gallbladder; thickened gallbladder wall; gallstones.
Sarcoidosis
SIGNS / SYMPTOMS
Patients may have erythema nodosum, chronic fatigue, and/or arthralgia.
INVESTIGATIONS
MRI brain: findings are varied and nonspecific, and include meningeal enhancement with or without periventricular white matter lesions.
Other investigations depend on clinical presentation.
Alcohol abuse
SIGNS / SYMPTOMS
Patients usually demonstrate evidence of alcohol withdrawal including hallucinations and tremor. History of excess alcohol consumption.
INVESTIGATIONS
Diagnosis is based on history and physical exam.
Stool exam and serology for tapeworm species: negative.
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