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Rheumatic and musculoskeletal disorders
Published in Rachel U Sidwell, Mike A Thomson, Concise Paediatrics, 2020
Rachel U Sidwell, Mike A Thomson
A clinical diagnosis of exclusion. Differential diagnoses: InfectionMalignancy, e.g. Leukaemia, neuroblastomaVasculitis, other connective tissue disease
What do diagnoses mean, and does it matter?
Published in Rolf Ahlzén, Martyn Evans, Pekka Louhiala, Raimo Puustinen, Medical Humanities Companion, 2018
The meaning of diagnoses is not only an academic question. For the patient, the end of uncertainty often means that something can be said about the prognosis. A diagnosis of exclusion (like Jake’s irritable bowel syndrome) means that the patient does not have certain other, often serious diagnoses like cancer.
Lower limb
Published in Tor Wo Chiu, Stone’s Plastic Surgery Facts, 2018
Primary lymphoedema where no precipitating cause can be found and is less common (10% in the United States) than secondary lymphoedema. It is effectively a diagnosis of exclusion. Primary lymphoedema can be either sporadic or inherited. The swelling in primary lymphoedema generally shows slower progression; it tends to begin distally and progress proximally (often it is the distal lymphatics that are most malformed/underdeveloped), whilst secondary lymphoedema often begins near the trunk and progresses distally.
Skew Deviation
Published in Journal of Binocular Vision and Ocular Motility, 2022
Skew deviation is a vertical ocular misalignment caused by disruption of vestibular input to the interstitial nucleus of Cajal (INC), involving the brainstem, the cerebellum and/or the thalamus. First described clinically, its variety of presentations and array of accompanying signs and symptoms made it difficult to characterize with certainty, and this, coupled with a lack of pathophysiologic knowledge, relegated it to a diagnosis of exclusion.1,2 In the past 20 years, work to define the function and pathway of the vestibular system1,3,4 has allowed us to clearly identify skew, use its presence or absence in specific settings to aid differentiation of central versus peripheral disruptions of the vestibular system5 and to predict the location of lesions when other signs are present. Ongoing research works to define the role of the vestibular sensory organs in higher order perception involving cognition and input from more than one sensory modality.6
Diagnostic route of cervicogenic dizziness: usefulness of posturography, objective and subjective testing implementation and their correlation
Published in Disability and Rehabilitation, 2021
Alessandro Micarelli, Andrea Viziano, Ivan Augimeri, Beatrice Micarelli, Donatella Capoccia, Marco Alessandrini
However, cervicogenic dizziness is a diagnosis achieved by exclusion criteria. A diagnosis of exclusion exists in situations where no single test is able to diagnose the condition, and the diagnosis cannot be verified by outcomes, imaging, laboratory values, or unique signs and/or symptoms [7,8]. Diagnoses of exclusion are challenging for healthcare practitioners because they require high levels of clinical skill and a strong understanding of the sequencing of proper tests and measures needed to rule out or rule in competing diagnoses. Such uncertainties in diagnostic assessment of cervicogenic dizziness reflect doubts regarding the causes underpinning the symptoms of imbalance, unsteadiness, and disorientation. Some authors have suggested the presence of faulty cervical proprioceptive inputs as a contributing factor [7,9]. It has been proposed that a disruption of the normal afferent signals from the upper cervical proprioceptors to the vestibular nuclei results in an inaccurate depiction of head and neck orientation in space [7,10], which would cause alteration of postural stability, and of head and eye movements control [10,11].
Pharmacological management of late-onset hypogonadism
Published in Expert Review of Clinical Pharmacology, 2018
Giulia Rastrelli, Mario Maggi, Giovanni Corona
Recently, HG has also been classified according to its reversibility and to the demonstration of an organic perturbation in the hypothalamus–pituitary–testis (HPT) axis [12]. When the latter condition is verified, HG is termed organic; otherwise, HG is considered functional. In particular, functional HG is characterized by ‘no recognizable structural intrinsic HPT axis pathology’ and by the lack of ‘pathologic etiologies’ [12]. Hence, it is a diagnosis of exclusion. Because of its functional nature, it may be reversible, if due to SHG [12]. Functional HG is often due to a deterioration of the HPT activity, due to morbidities impairing HPT axis function or to aging [12,13]. Recently, the role of aging in determining T deficiency has been questioned, in particular for SHG [12]. In fact, the mild decline in T associated with age is considered mostly related to a time-dependent accumulation of morbidities. Metabolic disturbances, such as type 2 diabetes mellitus (T2DM), obesity and metabolic syndrome (MetS), are the main morbidities associated with functional HG [12–15].