Differential diagnosis of elevated Creatine Kinase levels

High CPK levels may be seen in patients who have:

  • Brain injury or stroke
  • Convulsions
  • Delirium tremens
  • Dermatomyositis or polymyositis
  • Electric shock
  • Heart attack
  • Inflammation of the heart muscle (myocarditis)
  • Lung tissue death (pulmonary infarction)
  • Muscular dystrophies
  • Myopathy

Additional conditions may give positive test results:

  • Hypothyroidism
  • Hyperthyroidism
  • Pericarditis following a heart attack
  • Rhabdomyolysis

Differential Diagnosis of Creatine Kinase Elevation:

  • Myopathies
    • Carrier state (dystrophinopathies)
    • Channelopathies
    • Drug/toxin-induced
    • Inflammatory myopathies
    • Metabolinc myopathies
    • Muscular dystrophies
  • Motor neuron diseases
    • Amyotrophic lateral sclerosis
    • Postpolio syndrome
    • Spinal muscular atrophy
  • Neuropathies
    • Guillan-Barre syndrome
    • Chronic inflammatory dymyelinating polyneuropathy
  • Nonneuromuscular
    • Hypothyroidism/hypoparathyroidism
    • “Idiopathic hyperCKemia”
    • Increased muscle mass
    • Malignant hyperthermia
    • Medications
    • Race
    • Sex
    • Strenous exercise
    • Surgery
    • Trauma (EMG studies, IM, or SQ injections)
    • Viral illness

From: Jackson CE. A clinical approach to muscle diseases. Semin Neurol. 2008

Venance SL. Approach to the Patient With HyperCKemia. Continuum (Minneap
Minn). 2016 Dec;22(6, Muscle and Neuromuscular Junction Disorders):1803-1814.

Neurologists commonly receive consultation requests regarding the evaluation of patients with an elevated serum creatine kinase (CK), a condition known as hyperCKemia. This article outlines an approach to the history and examination of patients with hyperCKemia in order to narrow the localization and differential of an elevated CK and guide possible next steps. This article aims to help clinicians identify treatable or reversible etiologies as well as those that will change management.

Full-text for Emory users.

Created 06/12/14; updated 02/09/17. 

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