METABOLIC/ SPORADIC 

VIT B1 DEFICIENCY (WERNICKE)

CONFUSION/ OPHTHALMOPARESIS

GAZE EVOKED/ UPBEAT NYSTAGMUS

PERIPHERAL NEUROPATHY

​

HYPOPHOSPHATEMIA DEFICIENCY

WERNICKE MIMIC

​

HYPOMAGNESEMIA

ATAXIA/ UPBEAT NYSTAGMUS

​

VIT B6/VIT B12/ VIT E DEFICIENCY

​

HYPOTHYROIDISM

​

CELIAC DISEASE

ATAXIA/ LEG MYOCLONUS

NEUROPATHY/ DIARRHOEA

GOBBI SYNDROME: CEC SYNDROME

CELIAC DISEASE/ SEIZURES/ BILATERAL

MRI: OCCIPITAL CALCIFICATIONS

LAB: ANTI-TTG ANTIBODIES

SUPERFICIAL HEMOSIDEROSIS

​

SYPHILIS

DEMENTIA/ PSYCHIATRIC MANIFESTATIONS

MYELOPATHY (TABES DORSALIS)​

ARGYLL ROBERTSON PUPIL:

SMALL PUPILS/ NO DILATION IN DARK

NO REACTION TO LIGHT/ CONSTRICT WHEN FOCUSED 

RARE: PURE CEREBELLAR ATAXIA

DIAGNOSIS:

CSF: VDRL (INSENSITIVE)
CSF: TREPONEMAL ANTIBODY/ TPHA (HIGH SENSITIVE)
 

WHIPPLE'S DISEASE

OCULOMASTICATORY SKELETAL MYORHYTHMIA

DEMENTIA/ SUPRANUCLEAR OPHTHALMOPLEGIA

MENINGITIS/ CONFUSION/ HEADACHES

PSP PHENOTYPE: PARKINSONISM, UPGAZE RESTRICTION

VERTICAL SACCADE SLOWING

CONVERGENT DIVERGENT NYSTAGMUS (1HZ)

MYOCLONUS/ CHOREA/ MYORHYTHMIA (40%)

ATAXIA (10%)

ARTHRALGIA/ DIARRHOEA/ WEIGHT LOSS

LYMPHADENOPATHY

CAN PRESENT WITHOUT GI SYMPTOMS

DIAGNOSIS:

DUODENAL BIOPSY

CSF: PAS MACROPHAGES/ NORMAL CYTOLOGY(60%)

TROPHERYMA WHIPPLEI PCR: CSF/ BIOPSY

MRI:

FOCAL/ MULTIFOCAL WM LESIONS IN MES TEMPORAL LOBE/ THALAMUS/ HYPOTHALAMUS/ MIDBRAIN

PERIVENTRICULAR WMH/ PACHYMENINGITIS (10%)

CEREBRAL ATROPHY

RX:

TMP-SMX, DOXYCYCLINE/ 3RD GEN CEPHALOSPORINS

​

HEPATOCEREBRAL SYNDROME

ATAXIA/ PARKINSONISM

​