The 12 most hazardous neurological pitfalls…and their checklists

Neurology is a precarious specialty. Many neurological disorders are difficult to diagnose, and many neurological treatments are risky. Neurological error also leaves a high burden on patients, often resulting in death or permanent injury. It is therefore not surprising that the frequency and cost of neurological medical malpractice are high.

 

https://pixabay.com/en/hammer-books-law-court-lawyer-719066/

 

Neurology has the highest average indemnity payment of all specialties, and neurological malpractice cases are the most difficult to defend. The most common reason for neurological litigation is diagnostic error. This may manifest as wrong, missed, or delayed diagnosis. Diagnostic error is also responsible for the highest negligence payouts.

 

By Sven VolkensOwn work, CC BY-SA 4.0, Link

 

Neurological malpractice claims are often the result of incomplete or inaccurate neurological examination. Whilst neurologists and neurosurgeons bear the greatest burden of neurological malpractice cases, no group of doctors are immune from the frightening prospect of neurological medical negligence claims. Notable ‘victims’ include general physicians, orthopaedic surgeons, and emergency physicians. General practitioners are also at high risk of neurological negligence claims.

 

By Tracy Collins, CC BY-SA 2.0, Link

 

So what are the 12 high-stake, high-risk neurological diseases that threaten doctors and patients alike? Here they are…all linked to their safeguarding neurochecklists!

2. Stroke

4. Meningitis

8. Cervical artery dissection

9. Giant cell arteritis (GCA)

10. Multiple sclerosis (MS)

11. Epilepsy

12. Idiopathic intracranial hypertension (IIH) 

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Do you have any high-stake neurological pitfall not listed here? Then please leave a comment.
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The 130 interesting and unusual manifestations of HSP

The hereditary spastic paraplegias (HSP) are a diverse group of inherited disorders of the spinal cord. They may be transmitted dominantly or recessively, and through the X Chromosome. There are, at the last count, 79 different genetic forms of HSP. These are titled, rather confusingly, SPG1 to SPG79.

Middle spine. Michael Dorausch on Flikr. https://www.flickr.com/photos/chiropractic/3813001068

Some forms of HSP occur more frequently than others. SPG4 is the most common form, accounting for up to 40% of cases. SPG3 follows closely by causing 10% of HSPs. Other frequent forms are SPG1, SPG2, SPG7, SPG11, and SPG12. Some HSPs are so rare they have been reported in only single subjects or families.

Plastic spine. Michael Dorausch on Flikr. https://www.flickr.com/photos/chiropractic/3487324137

The cardinal feature of the HSPs is lower limb stiffness or spasticity. This often produces a characteristic stiff gait which, at its most extreme, causes the legs to cross each other, aptly called scissors gait. Another frequent feature is proprioceptive loss, the inability to tell where the limbs are positioned. This arises from impaired function of the posterior or dorsal collumns of the spinal cord.

Spinal Cord 3. GrenFlames 09 on Flikr. https://www.flickr.com/photos/greenflames09/116396753

Some forms of HSP manifest only with spasticity and are classified as Pure HSP. More often, however, HSP manifests with additional features and is then classified as Complex HSP.  Neurochecklists has explored all these aspects of HSP and has created a checklist for each HSP! To make things even easier, we have also produced the following summarising checklists:

 

By Doc. RNDr. Josef Reischig, CSc. – Author’s archive, CC BY-SA 3.0, Link

In the process of creating the HSP checklists, Neurochecklists has counted at least 130 different ways HSP manifests. Below is a full alphabetical list, each linked to an HSP that manifests with the feature. Bear in mind however that many HSPs present with the same features. We have placed an asterisk next to the most common HSP manifestations.

A

B

C

D

E-G

H

I-N

O-R

S

T-W

By RealmasteryOwn work, CC BY-SA 4.0, Link

 

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