Clinical distinction between stroke, cerebral malaria, and bacterial meningitis in patients with sickle cell disease

	History	Presenting symptoms	Examination	Laboratory findings
Acute stroke	May have a history of prior strokes or cognitive deficits	Sudden onset Focal abnormalities	Focal neurologic findings May have fever	No specific findings
Cerebral malaria	Young child (typically <5 years)	Gradual or sudden Generalized encephalopathy, coma or seizures	Altered mental status Coma at least one hour after termination of a seizure or correction of hypoglycemia	Hematuria Relative anemia Asexual forms of Plasmodium falciparum parasites on peripheral blood smear
Meningitis (bacterial or tuberculous)	Typically nonspecific	Gradual or sudden May have fever, meningeal signs, seizures	Fever Meningismus	White blood cells in CSF Low CSF glucose (CSF glucose <50 mg/dL or CSF/blood glucose ratio of <0.5) High CSF protein

This table describes clinical features that can be used to distinguish acute stroke from other conditions in resource-poor settings where routine CNS imaging is not available. Refer to UpToDate content on SCD in sub-Saharan Africa for further details of the evaluation and management. If the diagnosis is uncertain, it may be appropriate to treat for more than one condition until further information is obtained from the clinical course, laboratory findings, or microbiology.

CNS: central nervous system; SCD: sickle cell disease; CSF: cerebrospinal fluid.

Graphic 105545 Version 2.0

خرید پکیج

Clinical distinction between stroke, cerebral malaria, and bacterial meningitis in patients with sickle cell disease