دورية أكاديمية
Symptoms 'unexplained by organic disease' in 1144 new neurology out-patients: how often does the diagnosis change at follow-up?
| العنوان: | Symptoms 'unexplained by organic disease' in 1144 new neurology out-patients: how often does the diagnosis change at follow-up? |
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| المؤلفون: | Stone, Jon, Carson, A., Duncan, R., Coleman, R., Roberts, R., Warlow, C., Hibberd, C., Murray, G., Cull, R., Pelosi, A., Cavanagh, J., Matthews, K., Goldbeck, R., Smyth, R., Walker, J., MacMahon, A.D., Sharpe, M. |
| بيانات النشر: | Oxford University Press |
| سنة النشر: | 2009 |
| المجموعة: | HighWire Press (Stanford University) |
| مصطلحات موضوعية: | Original Articles |
| الوصف: | It has been previously reported that a substantial proportion of newly referred neurology out-patients have symptoms that are considered by the assessing neurologist as unexplained by ‘organic disease’. There has however been much controversy about how often such patients subsequently develop a disease diagnosis that, with hindsight, would have explained the symptoms. We aimed to determine in a large sample of new neurology out-patients: (i) what proportion are assessed as having symptoms unexplained by disease and the diagnoses given to them; and (ii) how often a neurological disorder emerged which, with hindsight, explained the original symptoms. We carried out a prospective cohort study of patients referred from primary care to National Health Service neurology clinics in Scotland, UK. Measures were: (i) the proportion of patients with symptoms rated by the assessing neurologist as ‘not at all’ or only ‘somewhat explained’ by ‘organic disease’ and the neurological diagnoses recorded at initial assessment; and (ii) the frequency of unexpected new diagnoses made over the following 18 months (according to the primary-care physician). One thousand four hundred and forty-four patients (30% of all new patients) were rated as having symptoms ‘not at all’ or only ‘somewhat explained’ by ‘organic disease’. The most common categories of diagnosis were: (i) organic neurological disease but with symptoms unexplained by it (26%); (ii) headache disorders (26%); and (iii) conversion symptoms (motor, sensory or non-epileptic attacks) (18%). At follow-up only 4 out of 1030 patients (0.4%) had acquired an organic disease diagnosis that was unexpected at initial assessment and plausibly the cause of the patients’ original symptoms. Eight patients had died at follow-up; five of whom had initial diagnoses of non-epileptic attacks. Seven other types of diagnostic change with very different implications to a ‘missed diagnosis’ were found and a new classification of diagnostic revision is presented. One-third of new neurology ... |
| نوع الوثيقة: | text |
| وصف الملف: | text/html |
| اللغة: | English |
| العلاقة: | http://brain.oxfordjournals.org/cgi/content/short/awp220v1Test; http://dx.doi.org/10.1093/brain/awp220Test |
| DOI: | 10.1093/brain/awp220 |
| الإتاحة: | https://doi.org/10.1093/brain/awp220Test http://brain.oxfordjournals.org/cgi/content/short/awp220v1Test |
| حقوق: | Copyright (C) 2009, Oxford University Press |
| رقم الانضمام: | edsbas.22AFCB77 |
| قاعدة البيانات: | BASE |
| DOI: | 10.1093/brain/awp220 |
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