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Worked up but not worked out: inconclusive cases
  1. Neil J Scolding1,2
  1. 1Neurology, Gloucestershire Royal Hospital Neurology Department, Gloucester, UK
  2. 2Clinical Neurosciences, University of Bristol, Bristol, UK
  1. Correspondence to Professor Neil J Scolding, Neurology, Gloucestershire Royal Hospital Neurology Department, Gloucester, Gloucestershire, UK; n.j.scolding{at}bristol.ac.uk

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It goes without saying that the words ‘anorak’ and ‘neurologist’ should never appear in close proximity—but we do like our diseases to behave in an orderly and seemly fashion. The correct clinical pace is important: progression over minutes to hours for strokes, days to weeks for inflammation and infection, weeks to months for tumours, months to years for neurodegeneration. Transgressing these rules is neither welcome nor helpful diagnostically (nor, sadly, rare). Anatomical boundaries should also be observed: neurological diseases are focused and disciplined. Parkinson’s disease specifically targets dopaminergic neurones, amyotrophic lateral sclerosis motor neurones and so on. Untidy systemic diseases (‘Internal Medicine’) spilling into the nervous system tend to know nothing of these neurological rules. Vasculitis, sarcoidosis, multitudinous infections are, as it were, all over the place (with notable exceptions, of course: leprosy and poliomyelitis perhaps as prime examples, and so qualifying as honorary neurological diseases).

By and large, neuroinflammatory diseases are conspicuously compliant with the anatomic boundary rule—after all, what would be the point of the immune …

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Footnotes

  • 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 None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.

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