Head turning sign

The head turning sign was first described as such more than 20 years ago but only recently have empirical studies of the sign in large cohorts of patients being assessed for cognitive disorders been reported. Although precise operationalisation of the sign has differed between studies, nevertheless it appears to be frequently observed in cognitive clinic patient cohorts, more so in Alzheimer’s disease than in other dementias and with an intermediate frequency in mild cognitive impairment.

Syncope in a new mother: a case of long-QT syndrome presenting after childbirth


Diagnosis of inherited arrhythmia syndromes, including long-QT syndrome (LQTS), is challenging; however, early detection and initiation of therapies can reduce otherwise high rates of mortality.

Two months following the birth of her first child a previously well 21-year-old female experienced four episodes of transient loss of consciousness (TLOC). 

The history was atypical for seizures but a video electroencephalogram (EEG) captured an episode with abnormal bifrontal epileptic discharge. She was commenced on levetiracetam. 

Missed opportunities to diagnose syphilis prior to the development of sight-losing uveitis

 

The incidence of syphilis in the UK is rapidly rising. Uveitis (intraocular inflammation) usually occurs in the secondary or later stages of syphilis infection and is sight-threatening.

Methods A retrospective analysis of the demographics, presentation, diagnosis, treatment and outcomes of patients with syphilitic uveitis managed in Newcastle from 2005–2016 was carried out.

Hypercalcaemia mimicking Huntington’s disease: lessons learned from delayed diagnosis

Diagnosis can prove challenging when a patient with a chronic neurological disease presents with acute deterioration. This is especially true in Huntington's disease, where cognitive impairment is prominent. We present a case of hypercalcaemia causing an acute deterioration in physical and cognitive function in a patient with Huntington’s disease. Similarity in clinical phenotype between hypercalcaemia and Huntington’s disease, as well as failure to appreciate the acute nature of the deterioration resulted in diagnostic delay and prolonged admission.

Patient safety symposium review: Better clinical decision making and reducing diagnostic error

A major amount of our time working in clinical practice involves thinking and decision making. Perhaps it is because decision making is such a commonplace activity that it is assumed we can all make effective decisions. However, this is not the case and the example of diagnostic error supports this assertion. Until quite recently there has been a general nihilism about the ability to change the way that we think, but it is now becoming accepted that if we can think about, and understand, our thinking processes we can improve our decision

Trainees and Members’ Committee symposium review: Identifying blood biomarkers to improve the diagnosis of stroke

Blood biomarkers are useful for the management of many diseases and could be useful for doctors caring for stroke patients, if they accurately predicted a diagnosis or recurrence of stroke. In a series of studies, we systematically reviewed the blood biomarker literature in stroke, determined the performance of existing blood biomarkers for the diagnosis of stroke and examined the value of markers of inflammation to predict recurrent stroke and myocardial infarction.

The use of wide-scale mental agility testing to identify people at risk of dementia: crucial or harmful?

The prevalence of dementia in the UK is rising rapidly and is predicted to double over the next 30 years. The NHS in England has been told to push for a rapid rise in dementia diagnosis rates, so that by 2015, two out of three cases are identified. The Prime Minister has raised the ‘dementia challenge’ as a priority for the NHS. While there is agreement on the need for action, debate arises over the nature of that intervention.

Venous thromboembolism: the role of the clinician

Deep venous thrombosis is a diagnosis that should be considered in any patient who presents with a swollen or painful leg. Clinical examination alone has low sensitivity and specificity for detecting patients with clots, and in recent years a diagnostic pathway has been devised that is more effective. This involves integration of three modalities: clinical assessment, D-dimer analysis and ultrasound.

A single-centre audit of junior doctors’ diagnostic activity in medical admissions

Practising doctors are distinguished from other healthcare staff by their role in making a clinical diagnosis. Huge changes in training and working practice in the past 15 years may have left many junior doctors ill equipped or preferring not to synthesise information to conclude a clerking with a diagnosis or differential diagnosis. This report details a retrospective study of acute medical admissions (AMU) first seen in the emergency department (A&E) and the diagnostic activity of junior doctors in both settings.