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Diagnostic reasoning in challenging cases
  1. Aaron L Berkowitz
  1. Neurology, UCSF, San Francisco, California, USA
  1. Correspondence to Dr Aaron L Berkowitz, Neurology, UCSF, San Francisco, California, USA; aaron.berkowitz{at}ucsf.edu

Abstract

Diagnostic reasoning relies on cognitive heuristics to recognise patterns of symptoms and signs in order to arrive at a diagnosis. These rules of thumb allow us to rapidly diagnose common conditions that present in typical ways. However, they may lead us astray when common conditions present atypically or when a patient has a rare condition or multiple conditions causing their constellation of symptoms, signs, and test results, rather than having a single diagnosis to explain them all. This article describes strategies to help counteract diagnostic pitfalls, to expand diagnostic possibilities and to make diagnostic progress with complex, multielement cases.

  • CLINICAL NEUROLOGY

Data availability statement

Data sharing not applicable as no datasets generated and/or analysed for this study.

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Data availability statement

Data sharing not applicable as no datasets generated and/or analysed for this study.

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Footnotes

  • X @AaronLBerkowitz

  • Contributors The author is solely responsible for the content of the article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests No relevant disclosures, but the author receives compensation through book royalties, serving on an editorial board, and serving as an expert consultant to legal firms.

  • Provenance and peer review Not commissioned. Externally peer reviewed by Richard Davenport, Edinburgh, UK, and Robin Howard, London, UK.