[The diagnostic process in Neurology: from clinical reasoning to assessment of diagnostic tests].
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Diagnostic Techniques, Neurological↗
Biomedical subjects
J Diaz Guzman
Publications and source records attributed to J Diaz Guzman.
[Theoretical bases for the critical reading of neurological articles on diagnostic tests].
Neurologists usually order diagnostic tests in clinical practice. A growing number and sophistication of the diagnostic tests in the last decades are evident. It is necessary for the clinician to know the operative functioning and accuracy of such tools. In addition, when reading a scientific paper about diagnostic test, the neurologist must pay attention to some methodological questions. These can be summarized as: a) blind and independent comparison between test result and gold standard, b) adequate gold standard, c) diagnostic test must be applied in appropriate spectrum of the disease, d) to appraise possible selection bias, and e) sufficient description of methodology, so it allow to replicate the study. Moreover, the evaluation should include data about test utility, and explain risk-benefit balance for the patients in whom it is used.
Bias↗
[Practical exercises on diagnostic test interpretation].
Although medical literature places great emphasis on therapy, diagnosis remains an essential part of medical practice. We present four clinical cases that show the interaction between pre-test probabilities and the accuracy of investigations (sensitivity, specificity, predictive values and likelihood ratios) The first example studies the influence of meningeal signs in the diagnosis of meningitis. The second one analyzes the diagnostic utility of investigations in patients suspected of dementia. The third example examines the change in the probability of carpal tunnel syndrome depending on the physical examination and the electrodiagnostic studies. The last example explains the use of ROC curves in the diagnosis of demyelinating disease with CSF-IgG index.
Adult↗
[Rhabdomyolysis and lumbosacral plexopathy in intravenous drug addict: report of a case].
There are several neuromuscular complications in the intravenous heroin addict (IHA). Someone may be due to direct toxic effect of the substance, but other ones may be associated to abuser's typical diseases (i.e. HIV infection). We present a 27 year-old IHA patient, HIV positive, that develop acute rhabdomyolisis with severe neuromuscular involvement, and consistent clinical and electrodiagnostic features of lumbosacral plexus neuropathy, forteen hours after an heroin inyection. Thirty months later, the patient is severely disabled, but her initial painfull and paretic picture have improved. The association of rhabdomyolisis-lumbosacral plexopathy (RLPS) is ocasionally reported. It has been proposed that RLSP is etiologically related to mecanic, toxic and immunologic factors.
Adult↗