Nam Chang Hyun, Jeon Beomseok
Department of Neurology, College of Medicine, Seoul National University, Seoul, Republic of Korea.
Neurologist. 2015 Oct;20(4):67-9. doi: 10.1097/NRL.0000000000000056.
Lesion localization based on patient's manifestation is a fundamental step in making a neurological diagnosis. However, it has been reported that diagnosticians are vulnerable to the effects of various cognitive biases during diagnostic processes.
A 69-year-old man with right-hand stiffness visited the Movement Disorder Clinic with the history of periodic limb movement syndrome and restless leg syndrome. His sensory and deep tendon reflex examination results were normal. Brain magnetic resonance imaging was normal. Corticobasal degeneration was considered as a possibility, but functional imaging studies including FP-CIT positron emission tomography were all normal. Later, cervical spine magnetic resonance imaging revealed a cervical meningioma at the C2-C3 levels and he showed tingling senses in his right ulnar 3 fingers and a hyperactive knee jerk on his right side, which were absent on the first examinations.
Insufficient clinical information (declarative shortcoming) and inherent heuristic pitfalls (procedural shortcoming) were 2 major causes of the diagnostic error. Especially, in the present case, cognitive biases from framing effects and anchoring heuristics misled the clinical reasoning during the process of localization.
基于患者表现进行病变定位是神经诊断的基本步骤。然而，据报道，诊断医生在诊断过程中容易受到各种认知偏差的影响。
一名69岁右手僵硬的男性因周期性肢体运动综合征和不安腿综合征病史就诊于运动障碍诊所。他的感觉和深腱反射检查结果正常。脑部磁共振成像正常。考虑可能为皮质基底节变性，但包括FP-CIT正电子发射断层扫描在内的功能成像研究均正常。后来，颈椎磁共振成像显示C2-C3水平有一个颈段脑膜瘤，他右侧尺侧3指出现刺痛感，右侧膝跳反射亢进，而首次检查时并无这些表现。
临床信息不足（陈述性缺陷）和固有的启发式陷阱（程序性缺陷）是诊断错误的两大主要原因。特别是在本病例中，框架效应和锚定启发式导致的认知偏差在定位过程中误导了临床推理。
