Neurology Department, Centro Hospitalar Universitário São João, Porto, Portugal.
Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, Porto, Portugal.
Eur J Neurol. 2024 Nov;31(11):e16021. doi: 10.1111/ene.16021. Epub 2023 Aug 13.
The art of diagnosis in clinical neurology requires attentive listening and careful observation. In certain situations, a fragment of the history or a physical sign may be so distinctive that it allows clinicians to evoke a specific diagnosis. This quick mental process was previously referred to as 'Augenblickdiagnose' ('diagnosis in the blink of an eye') in a seminal paper by Dr. William Campbell in 1998. We aimed to revisit this concept by providing additional clinical vignettes.
The authors wrote clinical vignettes using examples from their own clinical practice and performed a non-systematic review of influential neurology textbooks using the words 'pathognomonic' and 'highly suggestive'.
Twenty examples from various fields of neurology are presented in a table, stratified by major fields of neurology. A short educational reflection is provided for each diagnosis considered.
'Augenblickdiagnose' is an engaging teaching resource that also contributes to 'neurophilia', that is, a fascination for neurology, perhaps increasingly in today's modern neurology practice. However, multiple cognitive biases underlying mental shortcuts may lead to an incorrect diagnosis. It is important to stress that good clinical practice in neurology requires taking a thorough history and performing a careful neurological examination.
临床神经病学的诊断艺术需要细心倾听和仔细观察。在某些情况下，病史的一小部分或身体体征可能非常独特，以至于可以让临床医生联想到特定的诊断。这种快速的思维过程在 1998 年威廉·坎贝尔（William Campbell）博士的一篇开创性论文中被称为“瞬间诊断（diagnosis in the blink of an eye）”。我们旨在通过提供更多的临床案例来重新审视这一概念。
作者使用自己的临床实践中的例子编写了临床案例，并使用“特征性”和“高度提示性”这两个词对有影响力的神经病学教科书进行了非系统性回顾。
在一张表中呈现了来自神经病学各个领域的 20 个例子，按神经病学的主要领域进行分层。对每个考虑的诊断都提供了简短的教育反思。
“瞬间诊断”是一种引人入胜的教学资源，也有助于“神经癖”，即对神经病学的着迷，也许在当今的现代神经病学实践中越来越多。然而，思维捷径背后的多种认知偏见可能导致错误的诊断。重要的是要强调，神经病学中的良好临床实践需要进行全面的病史采集和仔细的神经系统检查。
