Clinical Symptoms and Differential Diagnosis of Hemifacial Spasm

Abstract Background Talaromyces marneffei (TM) primarily infects patients with co-morbidities that cause immunodeficiency, but non-secretory myeloma (NSMM) is rare. TSM and NSMM are associated with fever, osteolysis, and swollen lymph nodes, thereby making it difficult for clinicians to make differential diagnosis. In this case, we describe TM infection coexisting with NSMM. Case presentation We retrospectively reviewed the case of a male (without human immunodeficiency virus infection) with fever, thoracalgia, swollen lymph nodes, and subcutaneous nodules who presented to the First Affiliated Hospital of Guangxi Medical University in February 2014. Chest computed tomography revealed patchy infiltration and positron emission tomography/computed tomography showed increased metabolic activity in the lower-right lung, lymph nodes, left ninth rib, and right ilium. Pathological examination of the lung, lymph nodes, subcutaneous nodules, and bone marrow showed no malignancy, he was diagnosed with community-acquired pneumonia. His clinical symptoms did not improve after anti-bacterial, anti-Mycobacterium tuberculosis, and anti-non-M. tuberculosis treatment. Later, etiological culture and pathological examination of the subcutaneous nodule proved TM infection, and the patient was re-diagnosed with disseminated TSM, which involved the lungs, lymph nodes, skin, bone, and subcutaneous tissue. After antifungal treatment, the patient showed significant improvement, except for the pain in his bones. Imaging showed aggravated osteolysis, and bone marrow biopsy and immunohistochemistry indicated NSMM. Thus, we conclusively diagnosed the case as NSMM with TSM (involving the lungs, lymph nodes, skin, and subcutaneous tissue). His condition improved after chemotherapy, and he was symptom-free for 7 years. Conclusion TM infection is rare in individual with NSMM. Since they have clinical manifestation in common, easily causing misdiagnosis and missed diagnosis, multiple pathological examinations and tissue cultures are essential to provide a differential diagnosis.

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Change of differential diagnosis tactics in the process of clinical observation ofa patient

Bulletin of Siberian Medicine ◽

10.20538/1682-0363-2008-2-79-83 ◽

2008 ◽

Vol 7 (2) ◽

pp. 79-83

Author(s):

O. V. Kalinina

Keyword(s):

Lung Cancer ◽

Differential Diagnosis ◽

Clinical Observation ◽

Clinical Symptoms

The complicated ratios of clinical symptoms of internal lesions during central lung cancer are demonstrated in the article when changes of differential diagnosis tactics were required for diagnosing that necessary keeping is priority of the clinical appraisal of the results inspection patient.

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Difficulties of differential diagnosis of portal hypertension: case report

Medical Council ◽

10.21518/2079-701x-2021-5-92-101 ◽

2021 ◽

pp. 92-101

Author(s):

T. V. Penkina ◽

O. E. Berezutskaya ◽

D. T. Dicheva ◽

E. V. Partsvania-Vinogradova ◽

V. S. Larina ◽

...

Keyword(s):

Differential Diagnosis ◽

Portal Hypertension ◽

Portal Vein ◽

Portal Vein Thrombosis ◽

Clinical Case ◽

Clinical Symptoms ◽

Varicose Veins ◽

Small Diameter ◽

Magnetic Resonance Tomography ◽

Vein Thrombosis

In the article we analysed the difficulties of differential diagnosis of portal hypertension, considers a clinical case that illustrates the presented theoretical material. In the presented clinical observation, the patient’s disease was manifested by bleeding from the varicose veins of the esophagus. In most cases, portal hypertension syndrome in practicing clinicians is associated with liver cirrhosis, however, it is necessary to remember about the possibility of developing subhepatic portal hypertension, in particular as a result of the formation of portal vein thrombosis. If there are signs of portal hypertension, it is necessary to specify the level of obstruction to blood flow, that is, the form of portal hypertension (subhepatic, hepatic, suprahepatic). Often, portal vein thrombosis can be formed due to undiagnosed blood diseases that occur without any clinical symptoms. The provided clinical example demonstrates a case of portal hypertension in the outcome of a chronic form of myeloproliferative syndrome. Portal cavernoma is quite rare and it is formed due to multiple small-diameter venous structures that gradually replace the occluded vessel with a system of collaterals proximal and distal to the portal vein thrombosis site. In the formation of the diagnosis the main are radiation research methods, but the conclusions should be considered only in conjunction with the clinical evidence. The clinical case is interesting because a large cavernoma of the portal vein in a patient with subhepatic portal hypertension was regarded as a «solid formation» according to magnetic resonance tomography. According to the literature data, cavernous transformation has an external similarity to the tumor process, which expands the range of differential diagnosis and requires the exclusion of oncological formations.

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Osteomalacia in practice of endocrinologist: etiology, pathogenesis, differential diagnosis with osteoporosis

Osteoporosis and Bone Diseases ◽

10.14341/osteo12117 ◽

2020 ◽

Vol 22 (2) ◽

pp. 23-31

Author(s):

Olga O. Golounina ◽

Gyuzel E. Runova ◽

Valentin V. Fadeyev

Keyword(s):

Vitamin D ◽

Differential Diagnosis ◽

Vitamin D Deficiency ◽

Clinical Symptoms ◽

Fibroblast Growth Factor 23 ◽

Bone Matrix ◽

Bone Diseases ◽

Mineral Density ◽

Bone Formation Rate ◽

Metabolic Bone Diseases

Osteoporosis is the most common cause of low bone mineral density (BMD) and low-traumatic fractures in adults. However, differential diagnosis should also consider other causes of decreased BMD, including osteomalacia, as treatment for these conditions vary significantly. Osteomalacia is a systemic disorder characterized by decrease in bone strength due to of excessive accumulation of non-mineralized osteoid and uncoupling between bone matrix formation and mineralization. Osteomalacia in adults mostly develops due to severe vitamin D deficiency of any etiology, less often along with kidney pathology, mesenchymal tumors secreting fibroblast growth factor 23 or hereditary metabolic bone diseases. Clinical symptoms of osteomalacia are nonspecific and mostly manifest by generalized diffuse bone pain, muscle weakness, skeletal deformities and often go unnoticed at initial stage of the disease. Histomorphometric examination is the most accurate method of the diagnosis, which allows assessment of bone formation rate and calcification. The utmost priority of the treatment of osteomalacia of any etiology is the elimination of vitamin D deficiency, hypocalcemia, hypophosphatemia and prevention of bone deformities progression and muscle hypotension.

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The many faces of hemifacial spasm: Differential diagnosis of unilateral facial spasms

Movement Disorders ◽

10.1002/mds.23692 ◽

2011 ◽

Vol 26 (9) ◽

pp. 1582-1592 ◽

Cited By ~ 84

Author(s):

Toby C. Yaltho ◽

Joseph Jankovic

Keyword(s):

Differential Diagnosis ◽

Hemifacial Spasm ◽

The Many

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Hemifacial spasm caused by a spontaneous dissecting aneurysm of the vertebral artery

Journal of Neurosurgery ◽

10.3171/jns.1991.74.4.0650 ◽

1991 ◽

Vol 74 (4) ◽

pp. 650-652 ◽

Cited By ~ 20

Author(s):

Kengo Matsumoto ◽

Toshikazu Saijo ◽

Hideyuki Kuyama ◽

Shoji Asari ◽

Akira Nishimoto

Keyword(s):

Vertebral Artery ◽

Hemifacial Spasm ◽

Clinical Symptoms ◽

False Lumen ◽

Dissecting Aneurysm ◽

Left Vertebral Artery ◽

Complete Relief ◽

Vertebral Angiography ◽

Content Type ◽

Venous Phase

✓ The authors describe the first reported case of dissecting aneurysm presenting with hemifacial spasm. The patient was a 58-year-old woman with left hemifacial spasm of 2 years' duration. Cranial nerve examination was otherwise normal and no other clinical symptoms were observed. Vertebral angiography revealed a fusiform enlargement of the left vertebral artery and contrast medium remaining in the intramural false lumen in the venous phase. Microvascular decompression of the facial nerve with wrapping of the aneurysm resulted in complete relief of the hemifacial spasm.

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A diagnostic dilemma of two rare stroke mimics in a pediatric patient

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20173805 ◽

2017 ◽

Vol 4 (5) ◽

pp. 1886

Author(s):

Nidheesh Cheeyancheri Chencheri ◽

Pawan Subhash Kashyape ◽

Sonia Khamis ◽

Maha Mohammed Elamin Agna

Keyword(s):

Differential Diagnosis ◽

Pediatric Patient ◽

Male Patient ◽

Clinical Symptoms ◽

Diagnostic Dilemma ◽

Cns Vasculitis ◽

Tissue Diagnosis ◽

Stroke Mimics

A seven and half year-old male patient presented with clinical symptoms suggestive of stroke. However, the MRI showed atypical lesions in non-vascular distribution and with varying ages. This led to extensive investigations, which suggested a differential diagnosis of CNS neurosarcoidosis and primary CNS vasculitis. Both these are exceedingly rare conditions needing tissue diagnosis and prolonged immunosuppression

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What about the others: differential diagnosis of COVID-19 in a German emergency department

BMC Infectious Diseases ◽

10.1186/s12879-021-06663-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

David Fistera ◽

Annalena Härtl ◽

Dirk Pabst ◽

Randi Manegold ◽

Carola Holzner ◽

...

Keyword(s):

Emergency Department ◽

Differential Diagnosis ◽

Clinical Symptoms ◽

Respiratory Infections ◽

Health Care Systems ◽

Clinical Signs ◽

Vital Signs ◽

Main Diagnosis ◽

Clinical Trial Registry ◽

Airway Infections

Abstract Background The ongoing COVID-19 pandemic remains a major challenge for worldwide health care systems and in particular emergency medicine. An early and safe triage in the emergency department (ED) is especially crucial for proper therapy. Clinical symptoms of COVID-19 comprise those of many common diseases; thus, differential diagnosis remains challenging. Method We performed a retrospective study of 314 ED patients presenting with conceivable COVID-19 symptoms during the first wave in Germany. All were tested for COVID-19 with SARS-Cov-2-nasopharyngeal swabs. Forty-seven patients were positive. We analyzed the 267 COVID-19 negative patients for their main diagnosis and compared COVID-19 patients with COVID-19 negative respiratory infections for differences in laboratory parameters, symptoms, and vital signs. Results Among the 267 COVID-19 negative patients, 42.7% had respiratory, 14.2% had other infectious, and 11.2% had cardiovascular diseases. Further, 9.0% and 6.7% had oncological and gastroenterological diagnoses, respectively. Compared to COVID-19 negative airway infections, COVID-19 patients showed less dyspnea (OR 0.440; p = 0.024) but more dysgeusia (OR 7.631; p = 0.005). Their hospital stay was significantly longer (9.0 vs. 5.6 days; p = 0.014), and their mortality significantly higher (OR 3.979; p = 0.014). Conclusion For many common ED diagnoses, COVID-19 should be considered a differential diagnosis. COVID-19 cannot be distinguished from COVID-19 negative respiratory infections by clinical signs, symptoms, or laboratory results. When hospitalization is necessary, the clinical course of COVID-19 airway infections seems to be more severe compared to other respiratory infections. Trial registration: German Clinical Trial Registry DRKS, DRKS-ID of the study: DRKS00021675 date of registration: May 8th, 2020, retrospectively registered.

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A COMPLEX CASE OF DIFFERENTIAL DIAGNOSIS OF PULMONARY TUBERCULOSIS AND A NEUROENDOCRINE TUMOR

Journal of radiology and nuclear medicine ◽

10.20862/0042-4676-2018-99-5-259-263 ◽

2018 ◽

Vol 99 (5) ◽

pp. 259-263

Author(s):

N. L. Karpina ◽

L. N. Lepekha ◽

R. B. Amansakhedov ◽

O. M. Gordeeva ◽

A. V. Dudchenko ◽

...

Keyword(s):

Differential Diagnosis ◽

Pulmonary Tuberculosis ◽

Neuroendocrine Tumor ◽

Lung Diseases ◽

Clinical Symptoms ◽

Ct Scanning ◽

Young Female ◽

Complex Case ◽

Morphological Picture ◽

Neuroendocrine Lung Tumors

Pathomorphosis of tuberculosis and other lung diseases that have a similar clinical radiological and morphological picture leads to considerable difficulties and mistakes in the differential diagnosis of pulmonary processes. In particular, there are difficulties in the differential diagnosis of neuroendocrine lung tumors (NET) and pulmonary tuberculosis.A clinical case of timely diagnosis of a neuroendocrine tumor in a young female patient without clinical symptoms typical for NETs has been described. The main manifestations revealed by chest CT scanning were single focal consolidations. The diagnosis was confirmed by histological studies of surgery samples.

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