As practitioners, we often correlate the severity of presentation with prognosis. This, however, is a cognitive bias called premature closure. Premature closure is one of the most common cognitive errors in clinical medicine, in which clinicians rely on pattern recognition to make a rapid diagnosis while failing to consider other possible diagnoses. Although the prognosis of many neurologic diseases is correlated with the severity of signs, there are many important exceptions. These are referred to in this article as "severity-prognosis mismatch" conditions.
This article provides summaries of one of three severely neurologically affected patients. (Part two will showcase two more.) All three of these patients ultimately were diagnosed with conditions that carry a good-to-excellent prognosis. The purpose of this article is to demonstrate the important aspects of each of the represented neuroanatomic localizations described in these cases that led to the prioritization of a good prognosis disease. Knowledge of severity-prognosis mismatch conditions is critical to prevent falling trap to premature closure and potentially leading to severe case mismanagement and client misguidance.
Case 1: Bella
Case summary: Bella is an 11-year-old spayed female English Springer spaniel that was presented to an emergency clinic for a peracute inability to walk. According to her owner, she was sunbathing in the yard earlier in the day. The owner called for the dog to come into the house. Normally responsive, Bella did not return to the house. Her owner found her laterally recumbent and unable to stand. She has been an otherwise healthy dog that receives yearly vaccines and preventatives. She free roams in the yard.
On general physical examination, Bella had normal vitals, light pink mucous membranes, and a capillary refill time of two seconds. Thoracic auscultation and abdominal palpation were normal. Her peripheral lymph nodes were soft, small, and symmetrical. She had a full hair coat with no evidence of dermatopathy. A rectal exam was normal. The musculoskeletal examination was normal.
