Causes Of Misdiagnosis Research Articles

Misdiagnosis of Third Nerve Palsy.

This study identifies the diagnostic errors leading to misdiagnosis of 3rd nerve palsy and to aid clinicians in making this diagnosis. The objective of this article is to determine the incidence of misdiagnosis of 3rd cranial nerve palsy (3rd nerve palsy) among providers referring to a tertiary care neuro-ophthalmology clinic and to characterize diagnostic errors that led to an incorrect diagnosis. This was a retrospective clinic-based multicenter cross-sectional study of office encounters at 2 institutions from January 1, 2014, to January 1, 2017. All encounters with scheduling comments containing variations of "3rd nerve palsy" were reviewed. Patients with a documented referral diagnosis of new 3rd nerve palsy were included in the study. Examination findings, including extraocular movement examination, external lid examination, and pupil examination, were collected. The final diagnosis was determined by a neuro-ophthalmologist. The Diagnosis Error Evaluation and Research (DEER) taxonomy tool was used to categorize the causes of misdiagnosis. Seventy-eight patients referred were for a new diagnosis of 3rd nerve palsy. The main outcome measure was the type of diagnostic error that led to incorrect diagnoses using the DEER criteria as determined by 2 independent reviewers. Secondary outcomes were rates of misdiagnosis, misdiagnosis rate by referring specialty, and examination findings associated with incorrect diagnoses. Of 78 patients referred with a suspected diagnosis of 3rd nerve palsy, 21.8% were determined to have an alternate diagnosis. The most common error in misdiagnosed cases was failure to correctly interpret the physical examination. Ophthalmologists were the most common referring provider for 3rd nerve palsy, and optometrists had the highest overdiagnosis rate of 3rd nerve palsy. Misdiagnosis of 3rd nerve palsy was common. Performance and interpretation of the physical examination were the most common factors leading to misdiagnosis of 3rd nerve palsy.

Uncertainties, work conditions and testing biases: Potential pathways to misdiagnosis in point-of-care rapid HIV testing in Zimbabwe.

Disconcerting levels of misdiagnosis are common in point-of-care rapid HIV testing programmes in sub-Saharan Africa. To investigate potential pathways to misdiagnosis, we interviewed 28 HIV testers in Zimbabwe and conducted weeklong observations at four testing facilities. Approaching adherence to national HIV testing algorithms as a social and scripted practice, dependent on the integration of certain competences, materials and meanings, our thematic analysis revealed three underlying causes of misdiagnosis: One, a lack of confidence in using certain test-kits, coupled with changes in testing algorithms and inadequate training, fed uncertainties with some testing practices. Two, difficult work conditions, including high workloads and resource-depleted facilities, compounded these uncertainties, and meant testers got distracted or resorted to testing short-cuts. Three, power struggles between HIV testers, and specific client-tester encounters created social interactions that challenged the testing process. We conclude that these contexts contribute to deviances from official and recommended testing procedures, as well as testing and interpretation biases, which may explain cases of misdiagnoses. We caution against user-error explanations to misdiagnosis in the absence of a broader recognition of how broader structural determinants affect HIV testing practices.

Magnetic resonance imaging features of minimal-fat angiomyolipoma and causes of preoperative misdiagnosis.

BACKGROUNDMinimal-fat angiomyolipoma (mf-AML) is often misdiagnosed as renal cell carcinoma before surgery.AIMTo analyze the magnetic resonance imaging (MRI) features of mf-AML and the causes of misdiagnosis by MRI before operation.METHODSA retrospective analysis was performed on ten patients with mf-AML confirmed by surgical pathology, all of whom underwent preoperative MRI examination to analyze the morphological characteristics and MRI signals of the tumor.RESULTSMRI revealed a circular-like mass in 4/10 (40%) patients, an oval mass in 6/10 patients (60%), a mass with a capsule in 9/10 patients (90%), and a mass with a lipid component in 7/10 patients (70%). The diameter of the masses in all ten patients was from 11 to 47 mm; the diameter was between 11 mm and 40 mm in 8/10 (80%) patients and between 40 mm and 47 mm in 2/10 (20%) patients.CONCLUSIONAn oval morphological characteristic is strong evidence for the diagnosis of mf-AML, while a capsule and lipids are atypical manifestations of mf-AML.

Cell morphological analysis of hepatosplenic T-cell lymphoma gamma-delta type

Objective: To analyze the cell morphological features of hepatosplenic T-cell lymphoma (HSTCL) gamma-delta (γδ) type, differentiate from acute leukaemia (AL). Methods: This was a retrospective study. The clinical data of four cases of HSTCL γδ type who were treated in Hebei Yanda Ludaopei Hospital from 2009 to 2014 were collected. Their initial morphology diagnoses in other hospitals were all acute leukemia or myelodysplastic syndrome (MDS). Morphological analysis and cytochemical stains to their bone marrow (BM) aspiration and peripheral blood (PB) smears were completed when they had no response to previous chemotherapies, and the morphological reports were compared with results of immunophenotyping, chromosome, and T cell receptor (TCR) gene rearrangement. Results: The percentages of malignant cells in four patients' BM aspirations were 7.6%-40.0%, and in two patients' PB was 9% and 10%, respectively. The morphology of four cases had a very high similarity in Wright's stain. Predominantly medium-sized cells were seen, with rich cytoplasm and frequently one big conspicuous nucleolus. The malignant cells resembled blasts, especially monoblasts, but with coarse granular chromatin, more compact than that in monoblasts. When comparing to malignant myeloblast and lymphoblasts, HSTCL cells were larger and more irregular in cell shape, with more abundant cytoplasm and prominent nuclear irregularity. The cytochemistric stain played an important role in differential diagnosis. HSTCL malignant cells showed non-specific esterase (NSE) negative or focal punctate activity which couldn't be inhibited by sodium fluoride. Periodic acid-Schiff (PAS) stain was negative or positive with a form of coarse granules. The myeloperioxdase (MPO) stain was negative. Conclusion: Malignant cells of HSTCL γδ type have very distinct morphological features of mature lymphocytic neoplasm. The quality of Wright's stain, being short of complete cytochemical stains, lacking of awareness of this disease, and acute leukemia or MDS like appearance in some cases, result in the possibility of diagnostic error as malignant blast, and probably are main causes of misdiagnosis of HSTCL γδ type.

Analysis of misdiagnosis glomus jugulare tumor

Objective:To analyze the causes of misdiagnosis of patients with glomus jugulare tumor. Method:The clinical data of 116 patients with glomus jugulare tumor were retrospectively analyzed. Result:Among the 116 patients, 65 were misdiagnosed, the average duration of misdiagnosis was 4.90 years. The misdiagnosed diseases were chronic otitis media or cholesteatoma in 25 cases, neurological tinnitus or hearing loss in 16 cases, facial paralysis in 6 cases, external auditory canal masses in 4 cases, secretory otitis media in 3 cases, neck mass in 3 cases, intracranial neoplasma in 2 cases, middle ear cancer in 1 case, vocal cord paralysis in 1 case, stomatitis in 1 case, optic nerve head edema in 1 case, middle ear hemangioma in 1 case and vascular tinnitus in 1 case. Conclusion:The misdiagnosis of glomus jugulare tumor can be summarized as follows: the patients' first symptoms were not specific; lack of auxiliary examination, especially imaging examination; physicians have insufficient understanding of imaging and pathological examination of glomus jugulare tumor.

Central Serous Retinopathy with Atypical Presentation and Differential Diagnosis of Central Serous Retinopathy

Central serous retinopathy (CSR) is a multifactorial chorioretinal disorder which is characterized by subretinal fluid in the macula, usually affecting middle-aged men. Although it has often a self-limited course and good visual prognosis, the patients with atypical presentation and in chronic or recurrent episodes may suffer from various degrees of visual impairment. Misdiagnosis and improper treatment have a negative effect on the clinical and visual outcomes of CSR. Unfortunately, CSR is a great mimicker and is one of the commonest causes of misdiagnosis due to it has a wide presentation spectrum. Taking the clinical history in detail and interpreting all imagings correctly is so crucial for the differential diagnosis of CSR. In this study, CSR with atypical presentation and differential diagnosis of CSR were reviewed.

Analysis of misdiagnosis causes of suprasellar arachnoid cysts

Objective: To investigate the causes of misdiagnosis of suprasellar arachnoid cysts, analyze its characteristics and put forward the diagnostic basis and differential points. Methods: The clinical data fo 97 cases of suprasellar arachnoid cysts diagnosed and treated in the neurosurgery department of Beijing Tiantan Hospital and Hebei General Hospital from March 2015 to March 2019 were analyzed retrospectively. All patients underwent CT and MRI scans with obstructive hydrocephalus. 13 cases were misdiagnosed, including 7 males and 6 females. First visit age 1-31 years old, with an average age of 6.3 years. There were 10 patients younger than 6 years old. The remaining 15-year-old patients, 31-year-old patients and 26-year-old patients each have one case. 11 cases were misdiagnosed as obstructive hydrocephalus, 2 cases as cystic craniopharyngioma. Results: 13 cases were misdiagnosed and mistreated, 11 cases were treated with intraventricular and abdominal shunt, 9 cases were treated with neuroendoscopy and recovered well. One cases of intracranial hematomas underwent craniotomy again, the hematomas were removed again and the bone slise were decompressed. One case had fissured stable after shunt. There were no operative deaths and no complications in this group. After endoscopic reoperation, CT and/or MRI scans showed that the ventricle narrowed in varying degrees, some of them returned to normal size and the flow of cerebrospinal fluid (cerebrospinal fluid) was unobstruct at the end of magnetic resonance cerebrospinal fluid angiography (MRI) fistula after endoscopic reoperation. Conclusions: The incidence of suprasellar arachnoid cysts is low, it is rare in clinic and it is easy to misdiagnose and mistreate. At present, it is recognized that the best treatment methods are partial resection of endoscope cyst wall, cyst ventricle fistula and third ventricle floor fisthla.

Characteristics of Diffuse Leptomeningeal Glioneuronal Tumor With First-Episode Headache and Rapid Blindness Misdiagnosed as Viral Meningoencephalitis

Diffuse leptomeningeal glioneuronal tumor has a high degree of malignancy and high mortality. The purpose of this paper is to describe the characteristics of atypical diffuse leptomeningeal glioneuronal tumor and analyze the causes of misdiagnosis as viral meningoencephalitis. An adolescent female patient presented with headache, nausea, vomiting, sharp vision loss and cognitive dysfunction. After poor therapeutic effect of standard antiviral treatment, further inspection found that malignant cells were detected by cerebrospinal fluid (CSF) cytology; and enhanced magnetic resonance imaging (MRI) showed extensive enhancement of the leptomeningeal. In conclusions, when patient with unexplained high intracranial pressure, it is necessary to be alert to the diagnosis of diffuse leptomeningeal glioneuronal tumor. Multiple examinations of fresh CSF are helpful to increase the positive detection rate of tumor cells. Early diagnosis and active treatment are conducive to improving survival rate. J Med Cases. 2019;10(8):241-245 doi: https://doi.org/10.14740/jmc3347

Causes of misdiagnosis in assessing tubal patency by transvaginal real-time three-dimensional hysterosalpingo-contrast sonography.

This study aims to investigate the causes of misdiagnosis in assessing tubal patency by transvaginal real-time three-dimensional hysterosalpingo-contrast sonography (TVS RT-3D-HyCoSy), in order to improve the diagnostic efficiency of TVS RT-3D-HyCoSy. A total of 162 oviducts of 83 infertility patients were examined by TVS RT-3D-HyCoSy. These results were compared with the gold standard for laparoscopic dye studies, and the misdiagnosed cases were analyzed. TVS RT-3D-HyCoSy revealed that 68 oviducts were unobstructed and 94 obstructed. The results for the 144 oviducts were in line with the gold standard, while those for 18 oviducts were not. The accuracy rate of the TVS RT-3D-HyCoSy was 88.9%, and the misdiagnosis rate was 11.1%. The main causes of misdiagnosis included contrast medium countercurrent and diffusion, oviduct spasm, abnormal shape or position of the oviduct, pelvic adhesion, and poor imaging operation. TVS RT-3D-HyCoSy can well-evaluate tubal patency, and understand and improve the cause of misdiagnosis. Furthermore, the diagnostic efficiency of TVS RT-3D-HyCoSy can still be further improved.

Pitfalls in the Diagnosis of Acute Appendicitis in Tehran Children’s Hospital

Background: Appendicitis is the inflammation of the appendix. In spite of advances in the diagnosis and management of acute appendicitis, its morbidity is still significant. Despite widespread use of ultrasonography, computed tomography (CT) scan, and laparoscopy to diagnose appendicitis, the rate of misdiagnosis is not diminished accordingly. Methods: The current study aimed at determining the prevalence of primary misdiagnosis in pediatric patients presenting with appendicitis to Aliasghar Hospital, a tertiary referral center in Tehran, Iran from 2005 to 2015. Results: In the present study, the misdiagnosis rate of acute appendicitis was 7.4% in 10 years. Most causes of misdiagnosis were mesenteric adenitis, urinary tract infection, and gastroenteritis. Despite the availability of various diagnostic methods, the majority of patients with initial misdiagnosis were finally subjected to laparotomy for acute appendicitis. Ultrasound examination was useful in only 23% of the cases. Location of appendicitis in patients with initial misdiagnosis was retrocec in nine patients (53%), retroileum in five patients (29%), and pelvis in three patients (18%). Conclusions: Closer attention to signs and symptoms of acute appendicitis and higher clinical suspicion could reduce the rate of misdiagnosis and therefore minimize complications.

Histopathological characteristics of needle core biopsy and surgical specimens from patients with solitary hepatocellular carcinoma or intrahepatic cholangiocarcinoma.

BACKGROUNDPathological manifestations of hepatic tumours are often associated with prognosis. Although surgical specimens (SS) can provide more information, currently, pre-treatment needle core biopsy (NCB) is increasingly showing important value in understanding the nature of liver tumors and even in diagnosis and treatment decisions. However, the concordance of the clinicopathological characteristics and immunohistochemical (IHC) staining between NCB and SS from patients with hepatic tumours were less concerned.AIMTo introduce a more accurate method for interpreting the IHC staining results in order to improve the diagnostic value of hepatic malignancy in NCB samples.METHODA total of 208 patients who underwent both preoperative NCB and surgical resection for hepatocellular carcinoma (HCC) or intrahepatic cholangiocarcinoma (ICC) between 2008 and 2015 were enrolled in this study. The expression of CK19, GPC3, and HepPar1 were detected by IHC staining. Clinicopathological, NCB, and surgical data were collected and analysed using χ2 and kappa statistics.RESULTSMorphologically, the presence of compact tumour nests or a cord-like structure in NCB was considered the primary cause of misdiagnosis of HCC from ICC. The kappa statistic showed a moderate agreement in histomorphology (k = 0.504) and histological grade (k = 0.488) between NCB and SS of the tumours. A 4-tier (+++, ++, +, and -) scoring scheme that emphasized the focal neoplastic cell immunoreactivity of tumour cells revealed perfect concordance of CK19, GPC3 and HepPar1 between NCB and SS (k = 0.717; k = 0.768; k = 0.633). Furthermore, with the aid of a binary classification derived from the 4-tier score, a high concordance was achieved in interpreting the IHC staining of the three markers between NCB and final SS (k = 0.931; k = 0.907; k = 0.803), increasing the accuracy of NCB diagnosis C (k = 0.987; area under the curve = 0.997, 95%CI: 0.990-1.000; P < 0.001).CONCLUSIONThese findings imply that reasonable interpretation of IHC results in NCB is vital for improving the accuracy of tumour diagnosis. The simplified binary classification provides an easy and applicable approach.

Clinical Features of Diffuse Leptomeningeal Glioneuronal Tumor with Rapid Blindness Misdiagnosed as NMOSD and Literature Review

Diffuse leptomeningeal glioneuronal tumor has various clinical manifestations and is easily misdiagnosed. This article aims to describe the clinical features of a patient with diffuse leptomeningeal glioneuronal tumor misdiagnosed as optic neuromyelitis lineage disease (NMOSD), analyze the causes of misdiagnosis, and identify the disease with similar clinical manifestations. Adolescent women with decreased vision and headache, nausea, and vomiting were initially diagnosed as NMOSD. Immunotherapy was ineffective; enhanced MRI and cerebrospinal fluid cytology examination were completed and compared with classic meningeal carcinoma, NMOSD, multiple sclerosis, and Vogt-Koyanagi-Harada (VKH) syndrome. Diffuse leptomeningeal glioneuronal tumor was finally diagnosed in adolescent women with no history of tumor. Compared with NMOSD: no history of infection, no AQP4, MOG antibody, no spinal segmental abnormalities, immunotherapy was ineffective; compared with multiple sclerosis: no history of infection, no plaque, no oligoclonal antibody, immunotherapy was ineffective; compared with VKH syndrome: no history of infection, no fever, no treatment for immunotherapy; and compared with classic meningeal carcinoma: adolescents, no extracranial tumor lesions, super high protein, more different sugar excess. Patients with acute visual impairment should consider not only NMOSD, but also diffuse leptomeningeal glioneuronal tumor (DLGNT) and other diseases. DLGNT could not be excluded when CSF cytology and MRI plain scan were negative. The positive rate of malignant cells can only be increased by repeatedly sending fresh cerebrospinal fluid for examination; DLGNT needs to be differentiated from NMOSD, multiple sclerosis, VKH syndrome, and other diseases. Early diagnosis and molecular targeted therapy can improve the quality of life and prolong life.

Potential threat of pharyngo-esophageal diverticulum to thermal ablation treatment of thyroid nodule and rapid differential diagnosis through swallow contrast-enhanced ultrasonography

Objective To explore the potential risk of misdiagnosis of pharyngeal esophageal diverticulum(PED) for the treatment of thyroid nodules with thermal ablation and its rapid and effective method of diagnosis. Methods The process of diagnosis and treatment were reviewed on 5 cases of PEDs which had been misdiagnosed as thyroid nodules and recommended for thermal ablation therapy. A comprehensive analysis was carried out for the reasons of misdiagnosis, the timing and clues of the diagnosis as well as the advantage of swallow contrast-enhanced ultrasonography(sCEUS) in achieving rapid and correct diagnosis. Results The lack of recognition and vigilance to the acoustic image of PED were the direct causes of misdiagnosis. Five cases of PED misdiagnosed as thyroid nodules were all discovered by the same chief operator before thermal ablation. They were confirmed through sCEUS and mistreatment by ablation were fortunately avoided, but all true thyroid nodules requiring treatment were safely ablated. Conclusions PED is easily misdiagnosed as thyroid nodule.Improving the recognition and vigilance of the ultrasonic features of PED, strictly implementing the reconfirming ultrasound examination by the chief operator, and promptly conducting sCEUS are sensible measures to quickly correct the diagnosis and prevent wrong ablation of PED. Key words: Contrast-enhanced ultrasonography; Thermal ablation; Pharyngo-esophageal diverticulum; Thyroid nodule; Differential diagnosis

Errors in the Diagnosis of Stroke-Tales of Common Stroke Mimics and Strokes in Hiding.

Introduction:Stroke mimics are some of the common causes of misdiagnosis of stroke, with an attendant surfeit of finances and resources.Aim:We attempt to discuss some of the common neurological conditions mimicking stroke in the emergency.Methods:We reviewed the articles in English discussing stroke mimics in the last 5 years of publication.Purpose of the Review:We discuss the most common causes of stroke mimics encountered in neurological practice. In this short communication, we shall focus on the discussion of the diagnostic pitfalls and clinical clues that will help distinguish mimics from a true stroke.

Could you say that was an atrial flutter or not?

Özsoylu S, Akyıldız BN, Dursun A, Pamukçu Ö. Could you say that was an atrial flutter or not? Turk J Pediatr 2019; 61: 608-610. Muscle-tremor artefact is a potential cause of misdiagnosis of atrial arrhythmias on electrocardiography (ECG) monitoring. Such errors may lead to inappropriate and potentially dangerous therapies in some patients. We present a case of a patient with uncontrolled seizures whose bedside electrocardiogram monitor analysis appeared to demonstrate atrial flutter with 4:1 conduction through the AV node. The ECG monitor and ECG rhythm strip additionally showed a regular ventricular rate of 94 bpm with an underlying regular `saw-tooth` baseline. We applied cardioversion to convert to sinus rhythm. Amiodarone was loaded and added to the patients therapy who had atrial flutter after cardioversion. Echocardiogram was performed by a pediatric cardiologist and they noted that the atrial rate and ventricular rate were equal. After this, we began to suspect this situation might be a pseudoflutter due to his muscle contractions. We applied rocuronium to the patient to understand whether this was a pseudo-flutter or not. We saw that the ECG returned to normal sinus rhythm. Physicians especially working in intensive care units should be aware of artifact to avoid unnecessary therapeutic procedures. As Hippocrates said centuries ago `First, do no harm.`.

Retrospective analysis of ophthalmology consults to a tertiary academic teaching centre

ObjectiveThis study was conducted to analyse data from emergency ophthalmology referrals after-hours from different hospitals to identify the most common pathologies and compare accuracy of diagnoses. The primary objective was to identify common presenting entities and common causes of misdiagnosis in the emergency department to help guide education initiatives. DesignThis was a retrospective chart review that looked at consults occurring between September 1, 2015, and October 21, 2016. MethodsEmergency ophthalmology consults were reviewed and the date, time, age, sex, and provisional diagnosis were recorded. Ophthalmic diagnosis was compared with provisional diagnosis to compare agreement rate. Diagnoses were categorized to determine most frequent etiologies presenting on an emergent basis. ResultsA total of 697 consults were reviewed. The most common consults by diagnostic category were anterior segment (36.4%) and posterior segment (27.4%) pathologies. Together, these categories accounted for over 60% of all consults. Agreement between provisional diagnosis and final ophthalmology diagnosis was 65.8%. ConclusionsThere was a reasonable agreement rate between referring services diagnosis and ophthalmology diagnosis. The retrospective nature of this study and use of categories to determine agreement are potential biases and the agreement rate may not reflect clinical practice. Most common diagnoses were similar to previous studies. The authors noted several diagnostic categories that could be targeted as areas for medical education to help increase recognition in the primary care setting and facilitate appropriate ophthalmic referral.

Persisting Embryonal Infundibular Recess (PEIR): Two Case Reports and Systematic Literature Review

The persisting embryonal infundibular recess (PEIR) is a rare anomaly of the floor of the third ventricle with a debated pathogenesis. It can be a cause of misdiagnosis in the case of cystic lesions of the sellar and suprasellar area. To describe two recently evaluated cases and provide a systematic literature review. PEIR has been previously reported in six adult patients. Because in some cases it was associated with hydrocephalus and/or empty sella, a possible role of altered intracranial pressure in PEIR formation has been postulated. We evaluated two female patients, aged 34 and 50 years, referred to the Pituitary Surgery Clinic of the University of Brescia with the diagnosis of a sellar cyst and craniopharyngioma, respectively. Endocrine screening and visual field testing were normal. No signs of hydrocephalus or empty sella, as well as other indirect signs of intracranial hypertension, were visible on MRI scans. After a multidisciplinary reevaluation, diagnosis of PEIR was made in both cases. Both patients are followed but have not developed any disturbance related to the PEIR in the following 18 months. PEIR is a rare condition, probably unrecognized and the result of dysembriogenesis, which should be included in the differential diagnosis of cystic sellar lesions. Imaging features (funnel pituitary stalk and cyst in the sella) appear pathognomonic. A normal endocrine evaluation might help in the diagnosis and warrants conservative treatment.

Diagnostic Performance and Utility of Quantitative EEG Analyses in Delirium: Confirmatory Results From a Large Retrospective Case-Control Study.

Background. The lack of objective disease markers is a major cause of misdiagnosis and nonstandardized approaches in delirium. Recent studies conducted in well-selected patients and confined study environments suggest that quantitative electroencephalography (qEEG) can provide such markers. We hypothesize that qEEG helps remedy diagnostic uncertainty not only in well-defined study cohorts but also in a heterogeneous hospital population. Methods. In this retrospective case-control study, EEG power spectra of delirious patients and age-/gender-matched controls (n = 31 and n = 345, respectively) were fitted in a linear model to test their performance as binary classifiers. We subsequently evaluated the diagnostic performance of the best classifiers in control samples with normal EEGs (n = 534) and real-world samples including pathologic findings (n = 4294). Test reliability was estimated through split-half analyses. Results. We found that the combination of spectral power at F3-P4 at 2 Hz (area under the curve [AUC] = .994) and C3-O1 at 19 Hz (AUC = .993) provided a sensitivity of 100% and a specificity of 99% to identify delirious patients among normal controls. These classifiers also yielded a false positive rate as low as 5% and increased the pretest probability of being delirious by 57% in an unselected real-world sample. Split-half reliabilities were .98 and .99, respectively. Conclusion. This retrospective study yielded preliminary evidence that qEEG provides excellent diagnostic performance to identify delirious patients even outside confined study environments. It furthermore revealed reduced beta power as a novel specific finding in delirium and that a normal EEG excludes delirium. Prospective studies including parameters of pretest probability and delirium severity are required to elaborate on these promising findings.

Posterior Inferior Cerebellar Artery Aneurysm: Have You Ever Been Misdiagnosed?

The posterior inferior cerebellar artery aneurysm (PICAA), especially distal PICAA, is easily missed by a doctor, leading to misdiagnosis and treatment delays. The objective of this article is to report the computed tomography angiography (CTA) presentations of 30 cases of PICAA proved by digital subtraction angiography (DSA) or surgical operation, and analyze the causes of misdiagnosis of PICAA by CTA. Thirty cases of patients with PICAA that were proved by DSA or surgical operation were included in this study, all of whom underwent CTA before surgical procedure. The relationship between the locations of PICAA and the rates of missed diagnosis by CTA was analyzed. The detection rates of the PICAA by volume rendering (VR) images and original thin axial images of CTA were compared. Twelve cases (12 of 30, 40%) of aneurysm lied on the proximal end of posterior inferior cerebellar artery (PICA) (border with vertebral artery) and all of them (12 of 12,100%) were clearly displayed on the VR images of CTA and correctly diagnosed by doctors. Eighteen cases (18 of 30, 60%) of aneurysm lied on the distal part of the PICA, whereas only 2 of them (2/18, 11.1%) were displayed on the VR images and correctly diagnosed before surgical procedure. After surgical operation, the respective review of the CTA images demonstrated that all aneurysms (30 of 30, 100%) can be found on the thin axial images after careful observation and are shown on VR images after adjusting the display threshold when the locations of the PICAA through thin axial images were known, including the distal PICAA. Thin axial CT images are most important and reliable for the detection of distal PICAA. Overdependence on three-dimensional VR images of CTA is the main cause of misdiagnosis.

Take care of children with cystic fibrosis

Cystic fibrosis (CF) is one of the life-threatening and an autosomal recessive hereditary disease, which may involve lung, digestive and reproductive systems.The occurrence of CF varied with race, and is common in European and American, while rare in Asian.But recently, with the progress of medical technology, more and more Chinese children with CF have been found.Lacking of experience in CF diagnosis may be the main cause of misdiagnosis in China.The aim of this review is to elaborate the pathogenesis, clinical characteristics, diagnosis and treatment of CF, in order to improve the ability of identifying CF for Chinese pediatrician.Early identification and intervention can improve the prognosis and prolong the life cycle of Chinese CF children. Key words: Cystic fibrosis; Diagnosis; Child