missed subarachnoid hemorrhage

Subarachnoid hemorrhage is a classic emergency medicine diagnosis: rare, deadly, and easiest to miss in its early stages when there’s the greatest chance of intervention. A third of SAH die immediately, a third have longterm neurological consquences, and a third make a good recovery–and it’s this last group that has the highest miss rate and…

missed PE

Pulmonary embolism is both over-investigated in young people and missed in elderly people and those with comorbid conditions, and those with PE can have a benign or complicated course. I’ve shared some bounceback cases on PE, and here are a few studies to keep in mind to better assess and manage patients with potential PE…

missed appendicitis

Appendicitis classically presents as RLQ pain, fever, vomiting without diarrhea, a high WBC and normal UA. But pattern recognition is a great way to miss appendicitis–especially in children, women and the elderly–as the following studies makes clear.   CHILDREN The implications of missed opportunities to diagnose appendicitis in children. Acad Emerg Med 2013 Jun;20(6):592-6. In…

missed cerebellar infarction

Pitfalls in the Diagnosis of Cerebellar Infarction. Acad Emerg Med 2007;14:63-68. This retrospective review of 15 cases of misdiagnosed cerebellar infarction sheds light on a number of preventable errors. 28yo with headache, vertigo, nausea, fall to left, vision loss. Left sided weakness on exam but no documented gait. Normal CT/MRI. Diagnosed as migraine 38yo with…

missed long QT syndrome

Misdiagnosis of Long QT Syndrome as Epilepsy at First Presentation. Ann Emerg Med. 2009;54:26-32 This retrospective review of 31 patients (median age 21) with proved long QT syndrome found 39% experienced diagnostic delay after presenting with syncope or seizure, with a median delay of 2.4 years. A third of patients had EEGs and a sixth…