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COMMENTARY |
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Year : 2014 | Volume
: 7
| Issue : 2 | Page : 255 |
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Kearns-Sayre syndrome
Syed Shoeb Ahmad
Department of Ophthalmology, Queen Elizabeth Hospital, Kota Kinabalu, Malaysia
Date of Web Publication | 4-Feb-2014 |
Correspondence Address: Syed Shoeb Ahmad Queen Elizabeth Hospital, Kota Kinabalu Malaysia
Source of Support: None, Conflict of Interest: None | Check |
How to cite this article: Ahmad SS. Kearns-Sayre syndrome. Med J DY Patil Univ 2014;7:255 |
A misdiagnosis in neuro-ophthalmological conditions is a common occurrence. The variable and labile features of neuro-ophthalmological conditions, the dearth of expert neuro-ophthalmologists, the paucity of interaction between primary physician-ophthalmologist-other specialties and the difficulty in performing some of the investigations in these conditions, make diagnosis difficult. The paper, above, by Bhatnagar and Gupta, "Kearns-Sayre syndrome (KSS): A case report," highlights a case of KSS which was initially misdiagnosed as myasthenia gravis. For example, the most sensitive test to diagnose myasthenia gravis is single-fiber electromyography; a test, which is difficult to perform in most centers. [1]
There are a number of reports where KSS was misdiagnosed as some other condition, including psychosomatic disorders. [2] Thus it becomes important to understand the distinguishing features of neurological and neuro-ophthalmological conditions as well as the subtle variations, which might be seen in them. As pointed out by the authors the initial clinical presentation of one condition might mimic another condition. A more detailed history, better investigations and an open mind for other possibilities would lead to the correct diagnosis. During my stay at Aravind Eye Hospital, Madurai, India, I often noticed Dr. G. Natchiar, a doyen among neuro-ophthalmologists, working closely with neurosurgeons and other specialists.
In this age of malpractice litigations, it becomes all the more pertinent to be cautious in diagnosing problems. According to a definition, "a medical error is a preventable adverse effect of care, whether or not it is evident or harmful to the patient. This might include an inaccurate or incomplete diagnosis or treatment of a disease, injury, syndrome, behavior, infection or other ailment." [3] World-wide, about 180,000 patients die each year, partly as a result of iatrogenic injury. In the United States alone, about 15,000-19,000 malpractice lawsuits are brought up each year. [4] This case report is a reminder to be more vigilant and efficient in our management.
In conclusion, any neuro-ophthalmological condition should be explored for all possibilities. All relevant investigations and consultations should be performed. And finally, a multi-disciplinary approach is the best strategy in these cases.
References | | |
1. | Jayam Trouth A, Dabi A, Solieman N, Kurukumbi M, Kalyanam J. Myasthenia gravis: A review. Autoimmune Dis 2012;2012:874680. |
2. | Nørby S, Lestienne P, Nelson I, Nielsen IM, Schmalbruch H, Sjö O, et al. Juvenile Kearns-Sayre syndrome initially misdiagnosed as a psychosomatic disorder. J Med Genet 1994;31:45-50. |
3. | Available from: http://www.en.wikipedia.org/wiki/Medical_error. [Last accessed on 2013 May 31]. |
4. | Available from: http://www.en.wikipedia.org/wiki/Medical_malpractice. [Last accessed on 2013 May 31]. |
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