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Forme dell’errore clinico
No full textSono distinti vari generi di errori clinici. Sono maggiormente presi in considerazione quelli cognitivi che non riguardano la presa di decisione. Si sottolinea che tali errori possono dipendere da una scarsa conoscenza del sapere medico di base o consistere in violazioni di principi logici o metodologici; sia le conoscenze di base che i principi logici e metodologici dovrebbero essere usati o soddisfatti quando viene fatta la diagnosi della condizione di un particolare individuo. Si sostiene che da un punto di vista epistemologico il modo in cui gli errori cognitivi sono commessi o concepiti è teoricamente influenzato dalle vigenti teorie biomediche e dalle concezioni sulla natura delle malattie. Quindi vengono dati alcuni esempi di errori inferenziali deduttivi e si osserva che conclusioni diagnostiche false possono dipendere da errori di tal genere. Anche il conflitto tra le conclusioni di differenti spiegazioni fisiopatologiche può dipendere dall’uso di ragionamento deduttivo invalido. Inoltre, il conflitto sembra avere anche ragioni più profonde, come può risultare dal mettere criticamente a confronto le conclusioni epicritiche dell’anatomo-patologo e quelle del clinico. ---
Various kinds of clinical errors are distinguished. The cognitive ones, which do not concern decision making, are taken into a more specific account. It is emphasized that these clinical cognitive errors can consist of a defective mastery of basic pieces of medical knowledge or of violations of some logical or methodological principles which should be used or satisfied when diagnosing the condition of a particular individual. It is claimed that from an epistemological point of view the way in which the cognitive errors are made and conceived is theoretically affected by the scientific changes concerning the biomedical theories
and the conceptions of the nature of diseases. Then some examples of deductive inferential errors are given and it is remarked that false diagnostic conclusions can depend on such a kind of errors. Also the conflict among the conclusions of different physiological-pathological explanations can depend on the use of
invalid deductive reasoning. Moreover, their conflict seems to have also deeper reasons, as it can be pointed out in a critical comparative analysis of the pathologist’s and clinician’s conclusions
Clinical and diagnostic aspects of encephalopathy associated with autoimmune thyroid disease (or Hashimoto's encephalopathy)
No full textEncephalopathy associated with autoimmune thyroid disease, currently known as Hashimoto's encephalopathy, but also defined as corticosteroid-responsive encephalopathy associated with autoimmune thyroiditis, is a relatively rare condition observed in a small percentage of patients presenting with autoimmune thyroid disease. It consists of a subacute, relapsing-remitting, steroid-responsive encephalopathy characterised by protean neurologic and neuropsychiatric symptoms, diffuse electroencephalographic abnormalities and increased titres of antithyroid antibodies in serum and/or in cerebrospinal fluid. Most of the cases presenting this neurologic complication are affected by Hashimoto's thyroiditis or, less frequently, by other autoimmune thyroid diseases, chiefly Graves' disease.
The pathogenesis of this encephalopathy is still unknown and largely debated, because of extremely varied clinical presentation, possibly referable to different aetiologic and pathophysiologic mechanisms, as confirmed by the two clinical cases we report in this paper. Autoimmune aetiology is, however, very likely in view of the well established favourable response to corticosteroid administration. Both vasculitis and autoimmunity directed against common brain-thyroid antigens represent the most probable aetiologic pathways.
Clinical manifestations include consciousness changes, neurologic diffuse or focal signs, headache, and altered cognitive function. Although unspecific, cerebral oedema has also been described. Cerebrospinal fluid examination often discloses an inflammatory process, with a mild increase in protein content and occasionally in lymphocyte count. In this review, clinical criteria for the diagnosis of defined, probable, or possible encephalopathy associated with autoimmune thyroid disease are suggested. Corticosteroid therapy currently allows us to obtain rapid remission of disease symptoms, but adverse outcomes as well as spontaneous remissions have also been reported
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