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Orofacial pain is a worldwide pain problem, with many patients unable to find appropriate diagnosis and treatment. Orofacial pain includes pain arising from the odontogenic and nonodontogenic structures in the head and neck region. Dental clinicians need to have a thorough knowledge and skill to diagnose, manage, and treat patients with odontogenic pain or refer patients for treatment of nonodontogenic pain to specialists such as orofacial pain specialists, neurologists, otolaryngologists, and rheumatologists. More often, dental practitioners diagnose patients with a temporomandibular disorder (TMD), and when treatment is ineffective, term it "atypical facial pain." The first requirement for effective treatment is an accurate diagnosis. Dental clinicians must be aware of giant cell arteritis (GCA), a chronic large-vessel vasculitis, primarily affecting adults over the age of 50 years, as it frequently mimics and is misdiagnosed as TMD. GCA is associated with loss of vision, and stroke and can be a life-threatening disorder. Therefore, diagnostic testing for GCA and differential diagnosis should be common knowledge in the armamentarium of all dental clinicians. Historically, temporal artery biopsy was considered the definitive diagnostic test for GCA. Temporal artery ultrasound (TAUSG), a safe and noninvasive imaging modality, has replaced the previous diagnostic gold standard for GCA, the temporal artery biopsy, owing to its enhanced diagnostic capabilities and safety profile. The present case report describes a patient with GCA, and the role TAUSG played in the diagnosis. Case report: A 72-year-old woman presented with left-sided facial pain, jaw claudication, dysesthesia of the tongue, and episodic loss of vision of 2 years' duration. She was diagnosed with and treated for a myriad of dental conditions including endodontia and temporomandibular joint therapy with no benefit. A thorough history and physical examination, combined with serologic analysis, led to the diagnosis of GCA and TAUSG, which confirmed the diagnosis. Conclusion: This report underscores the responsibility of differential diagnosis and early recognition of GCA facilitated by TAUSG in optimizing treatment outcomes as a viable, noninvasive diagnostic tool. [ABSTRACT FROM AUTHOR]

This study aimed to determine whether choroid plexus volume (CPV) could differentiate multiple sclerosis (MS) from its mimics. A secondary analysis of two previously enrolled studies, 50 participants with MS and 64 with alternative diagnoses were included. CPV was automatically segmented from 3T magnetic resonance imaging (MRI), followed by manual review to remove misclassified tissue. Mean normalized choroid plexus volume (nCPV) to intracranial volume demonstrated relatively high specificity for MS participants in each cohort (0.80 and 0.76) with an area under the receiver-operator characteristic curve of 0.71 (95% confidence interval (CI) = 0.55-0.87) and 0.65 (95% CI = 0.52-0.77). In this preliminary study, nCPV differentiated MS from its mimics.

Background: Chronic active Epstein-Barr virus (CAEBV) colitis is a rare disease with clinical and endoscopic manifestations very similar to those of inflammatory bowel disease (IBD). In clinical practice, it is easy to be misdiagnosed and mistreated, leading to poor clinical outcomes. Case presentation: We report a case of a 56-year-old Chinese woman who presented with 6 years of intermittent severe diarrhea, fever, and abdominal pain. Ulcerative colitis was initially suspected. The patient's clinical symptoms were partially relieved after treatment with mesalazine and probiotics. However, the symptoms were repeated and improved after supportive and symptomatic treatment each time. Colonoscopy revealed multiple mucosal erosion and edema in the colon, EBV-encoded small RNA 1/2 in situ hybridization in the pathological tissue of the colon was positive (20/HP), and EBVDNA in the peripheral blood was positive. CAEBV colitis was diagnosed. The patient was given dexamethasone and acyclovir, and she was improved after treatment. Unfortunately, she was discharged without outpatient follow-up, and similar symptoms recurred one year later, with similar colonoscopy and pathological examinations. Symptoms were relieved after dexamethasone treatment. Conclusion: This case highlights the diagnostic challenges posed by nonspecific clinical manifestations of CAEBV colitis, which should be included as a differential diagnosis in patients with recurrent diarrhea and fever to avoid misdiagnosis. [ABSTRACT FROM AUTHOR]

Recognizing neuromyelitis optica spectrum disorder (NMOSD) and differentiating NMOSD from multiple sclerosis (MS) and other disorders can be challenging yet it is extremely important to prevent misdiagnosis, defined in this review as the incorrect diagnosis of patients who truly have NMOSD, particularly in aquaporin-4-IgG (AQP4-IgG)-seronegative cases. The heterogeneity of clinical presentations and wide range of differential diagnoses often lead to missed diagnoses of NMOSD. Misapplication of the 2015 NMOSD criteria and misinterpretation of clinical and neuroradiological findings are relevant factors associated with misdiagnosis in clinical practice. Despite the presence of a specific biomarker for NMOSD (AQP4-IgG), misdiagnosis rates have been reported as high as 35%. Studies indicate that misdiagnosed patients often undergo unnecessary prolonged immunotherapy, leading to health risks and increased morbidity. Accurate definitive diagnosis is crucial as long-term outcomes and treatment approaches differ based on the correct diagnosis, and inappropriate immunotherapy can lead to disability in NMOSD patients. This review outlines factors linked to NMOSD misdiagnosis and briefly discusses strategies to reduce misdiagnosis. [ABSTRACT FROM AUTHOR]

Background: Anticoagulants increase the risk of cardiac tamponade in patients with pericardial effusion (PE). Therefore, inappropriate administration of them in the presence of PE can lead to a catastrophic outcome. This study presents a patient with a provisional misdiagnosis of venous thromboembolism (VTE). Case Presentation: An 83-year-old Iranian female was transferred to the emergency department of a tertiary cardiology hospital complaining of neck swelling concomitant with chest pain and dyspnea. The patient had been diagnosed with jugular vein thrombosis in another local center, and since the chief complaint was neck swelling, she underwent Doppler sonography, and the diagnosis was confirmed. Subsequently, the treatment with unfractionated heparin was started. After 5 h, considering the worsening of symptoms with the suspicious diagnosis of COVID-19 based on her symptoms and laboratory data, a chest computed tomography scan was requested, which showed a massive PE. Subsequently, transthoracic echocardiography confirmed the diagnosis. The patient was immediately transferred to the operating room and underwent pericardiotomy. The post-surgery period was uneventful, and she was discharged 5 days later. Conclusion: Patients with viral infections, specifically COVID-19, are at risk of undiagnosed severe pericardial effusions. Venous stasis in the jugular veins due to PE can mimic jugular vein thromboembolism, causing a wrong diagnosis. Since treating thrombosis can exacerbate tamponade to hemodynamic instability and collapse, sufficient investigation before starting anticoagulants is necessary. Clinical key message: Distinguishing VTE from PE is not always straightforward. Therefore, it is important to ensure physicians have reached an appropriate level of certainty about their diagnosis by performing precise diagnostics before using anticoagulants. Mismanagement with anti-thrombotics can result in catastrophic consequences. Therefore, taking an accurate history, performing a precise physical examination, and using rapid and available diagnostic modalities can avoid delays in definitive management. [ABSTRACT FROM AUTHOR]

Epithelioid sarcomas are rare soft tissue tumors and have possibility to involve the peripheral nerve and present as sensory and motor disorders. The symptoms are similar to those of nerve compression diseases. This situation is extremely rare in clinic and was only reported as several case reports in literature. It can be easily ignored and misdiagnosed in clinic and may bring out severe outcomes. From January 2003 to December 2017, a retrospective analysis of ten patients with epithelioid sarcomas which involved the peripheral nerves was made. The medical data, detailed clinical courses and the follow-up results were stated. In these cases, the tumors invaded the median nerve, ulnar nerve, radial nerve, brachial plexus, sciatic nerve and presented as relative symptoms. Early diagnosis and treatment are the keys to better prognosis. We recommended high-resolution ultrasound as a standard diagnostic tool for nerve compression syndromes not only reveal the morphological structure of the peripheral nerve, but also discover the tumor involving the nerve. Adequate surgical methods including wide resection and lymph node dissection if necessary. The manners of functional reconstruction need to be applied flexibly by the doctors. Postoperative rehabilitation is important for functional recovery. We want to share our experiences in the diagnosis and treatment to overcome this particular condition. [ABSTRACT FROM AUTHOR]

Introduction: Although giant cystic pheochromocytoma and paraganglioma (PPGL) are uncommon, they can be life-threatening when it occurs. Unfortunately, prior case reports have shown that giant cystic PPGLs are highly susceptible to diagnostic errors. Therefore, this study aimed to explore giant cystic PPGLs by comparing them with non-cystic PPGLs, defining the clinical features of the affected patients, and analyzing the characteristics of misdiagnosis and mistreatment associated with PPGLs. The goal is to provide insights for the timely and accurate diagnosis and treatment of giant cystic PPGLs. Methods: A total of 170 cases of pheochromocytoma and paraganglioma (PPGL) diagnosed at the First Affiliated Hospital of Chongqing Medical University from April 2011 to April 2020 were confirmed through clinical evaluation, measurement of catecholamine metabolites, imaging studies, or surgical pathology. The patients were classified into two groups based on the maximum tumor diameter and the presence of cystic components. The clinical characteristics of patients in the giant cystic group, including timely diagnosis and instances of misdiagnosis, are summarized. Additionally, the differences in demographics, clinical manifestations, laboratory examinations, imaging features, treatment approaches, and tumor characteristics between the two groups were analyzed. Results: Among the 17 patients in the giant cystic group, eight (47.1%) patients were misdiagnosed. The misdiagnosis and mistreatment characteristics of PPGLs were as follows: female (50%); median age, 51 years; normal blood pressure; greater mass effect at onset; larger tumors; median time to diagnosis extension, 180 days; and misdiagnosed disease, which was mainly tumors of adjacent organs, the digestive system, the cardiovascular system, the urinary system, the nervous system, or the endocrine system. The giant cystic group had greater mass effects than did the non-cystic group (P < 0.05). The proportion of patients with the triad of pheochromocytoma (heart palpitations, sweating and headache) and hypertension was lower; however, this difference was not statistically significant. The blood MN (metanephrine) level was greater, and the hemoglobin and blood low-density lipoprotein cholesterol (LDL-cholesterol) levels were lower (P < 0.05). The proportions of patients with tumor calcification and hemorrhagic necrosis were significantly greater (P < 0.05). There was more intraoperative bleeding, more patients who underwent blood transfusions, and a longer postoperative hospital stay; however, the difference was not statistically significant. Conclusion: Giant cystic pheochromocytomas and paragangliomas (PPGLs) are rare, and their clinical manifestations are atypical. Additionally, imaging findings can be challenging to identify due to the presence of large space-occupying adjacent organs. As a result, these giant cystic lesions of unknown origin are often misdiagnosed. Early biochemical examination, in conjunction with imaging characteristics, is essential to accurately determine the nature of the tumor and reduce the rate of misdiagnosis. [ABSTRACT FROM AUTHOR]

Background: We evaluated comprehension and application of the 2015 neuromyelitis optica spectrum disorder (NMOSD) criteria core elements by neurologists in Latin America (LATAM) who routinely diagnose and care for NMOSD patients by (i) identifying typical/suggestive NMOSD syndromes, (ii) detecting typical MRI NMOSD lesions and meeting MRI dissemination in space (DIS) criteria, and (iii) evaluating historical symptoms suggestive of NMOSD. Methods: We conducted an anonymous, voluntary, self-administered web- and case-based survey cross-sectional study from October 2023 to January 2024 of neurologists identified through the LACTRIMS database. Questions were presented first through iterative clinical cases or imaging, followed by questions directly evaluating comprehension of definitions. "Correct" responses were based on the 2015 criteria and adjudicated by the consensus of the experts leading the project. Results: A total of 106 neurologists (60.3% female; mean age: 46.6 ± 12.5 years) were included. Between 10.4% and 49.1% of neurologists inaccurately identified clinical or paraclinical aspects for DIS and 32.1% accurately identified the three non-cardinal (brainstem, diencephalic, and cerebral) syndromes for seronegative patients. Between 35.8% and 64.1% of neurologists identified the "optimal timing" of AQP4-IgG testing (e.g., during an attack or before receiving immunosuppressant treatments, among others); 56.6% considered live cell-based assay as the gold standard method for serological testing. Most neurologists accurately identified typical NMOSD MRI lesions, but periventricular, juxtacortical/cortical, fluffy infratentorial, corticospinal tract, and hypothalamic lesions were frequently misidentified. Conclusion: Clinical scenarios were identified where the 2015 NMOSD criteria were susceptible to misinterpretation and misapplication by expert neurologists in LATAM. Implementing collaborative educational initiatives could improve NMOSD diagnosis and raise patient care standards. [ABSTRACT FROM AUTHOR]

This case highlights the importance of considering Neuro‐Behçet's disease (NBD) in the differential diagnosis of multiple sclerosis (MS), particularly in patients presenting with neurological manifestations, abnormal magnetic resonance imaging (MRI) findings, and systemic symptoms consistent with Behçet's disease (BD). [ABSTRACT FROM AUTHOR]

Background/Objectives: Inexperienced dentists and dental students are especially prone to misdiagnosis, and this represents a huge problem regarding antimicrobial stewardship. We aimed to develop a mobile app for rational antibiotic prescribing in dentistry based on local–systemic symptoms and patient factors, rather than solely on diagnosis, to tackle misdiagnosis. Methods: The study involved 64 participants, 50 of which were third-year dental students attending a pharmacology course focusing on antimicrobials, comprising lectures and practical sessions without (noAPP group, n = 22) or with (APP group n = 28) the assistance of a mobile application. The other 14 participants were practicing dentists who decided to register and use the application. All registered users of the application were asked to take a feedback survey, while learning outcomes were evaluated via a pharmacology quiz. Results: A decision tree was used for application development. In total, 76 impressions were collected on the application. The majority of the impressions were related to odontogenic–endodontic infections. Multiple linear regression analysis did not reveal differences in survey responses between practicing dentists and undergraduate students in the feedback survey responses. There was a significant difference in the mean pharmacology test scores between the noAPP and APP groups (5.50 ± 1.80 vs. 7.21 ± 1.03, p = 0.0001). Conclusions: The dentalantibiotic.com application was developed to support rational antibiotic prescribing, in view of tackling misdiagnosis, among inexperienced dentists, as well as to assist in undergraduates' pharmacology learning, and the current study shows its large impact as an educational tool. The majority of participants considered it easy to use, efficient in facilitating the right antibiotic choice, and useful for everyday decision-making. [ABSTRACT FROM AUTHOR]

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The vast majority of GP appointments had to move from in-person to remote consultation during the pandemic. Rather than phasing this out now that the threat of the coronavirus has begun to ebb, the UK government has announced that digital-first primary care will continue for the foreseeable future. While remote consultation can be beneficial on several fronts, it can compromise professional identity, therapeutic alliance, patient safety and access to healthcare. A hasty push towards normalising digitally-enabled care may therefore increase the risk of misdiagnoses, medical negligence, unnecessary referrals and health inequity. To enhance the gains and iron out the challenges associated with IT-led triage and consultations, it is important to reflect on the lessons learned from the pandemic. [ABSTRACT FROM AUTHOR]

Cardiac myxoma is considered the most common primary cardiac tumor and has been reported to cause different neurological complications through distinctive mechanisms, including pseudovasculitis. Herein, we present and review a case of a young male with a previous history of ischemic stroke who presented with multiple territorial ischemic insults in the presence of a presumed diagnosis of vasculitis. Once further workup was done, he was found to have a left atrial myxoma. [ABSTRACT FROM AUTHOR]

Background: Cervical choriocarcinoma is an extremely rare malignancy that is often misdiagnosed due to its nonspecific symptoms, such as vaginal bleeding. Case report: A 39-year-old female presented to the emergency department of the First Affiliated Hospital of Sun Yat-sen University with vaginal bleeding and a serum β-human chorionic gonadotropin (β-HCG) level of 229,386 mIU/mL. Initially, she was misdiagnosed with cervical pregnancy and subsequently underwent selective uterine artery embolization and cervical mass excision. However, pathological examination revealed the diagnosis of cervical choriocarcinoma. Conclusion: This case highlights the propensity for misdiagnosis of cervical choriocarcinoma. Selective uterine artery embolization proves to be an efficient measure to manage hemorrhage and potentially avoid unnecessary hysterectomy. [ABSTRACT FROM AUTHOR]

Background: During embryogenesis, the spleen undergoes intricate developmental processes, originating from mesenchymal cells in the dorsal mesentery. An accessory spleen, a common anomaly found in autopsies and abdominal CT scans, can often be mistaken for different types of tumors. To the best of our knowledge, this is the first case in Syria documenting the occurrence of 3 accessory spleens in a patient who had previously undergone splenectomy. Case presentation: A 33-year-old male presented with right hypochondrium pain, sharp and radiating to the right flank, exacerbated by movement and large meals. Past medical history included mild Irritable Bowel Syndrome (IBS) and splenectomy due to a traumatic accident in childhood. On admission, vital signs were stable, with abdominal tenderness in the right upper quadrant. Laboratory investigations showed normal values. Ultrasound revealed a lobulated mass at the right adrenal gland (4.5 × 5 cm) with an isoechoic to hypoechoic texture. Multi-slice computed tomography (MSCT) Scan showed multiple nodules in the right adrenal gland, regular in shape, exerting a compressive mass effect, and significant lymphadenopathy around the abdominal aorta. Elevated metanephrine levels raised suspicion of an extra-adrenal pheochromocytoma. Laparoscopic surgery was performed, revealing accessory spleens and normal adrenal tissue with no malignancy. Conclusion: Healthcare providers should consider accessory spleens as a differential diagnosis for masses near the adrenal glands. Multiple accessory spleens in the adrenal region can complicate cases. Accessory spleens in uncommon locations like the adrenal glands can be challenging to diagnose and manage. [ABSTRACT FROM AUTHOR]

Background: Cerebrospinal fluid rhinorrhea is a rare condition characterized by the abnormal leakage of cerebrospinal fluid from the intracranial space into the sinonasal cavity. It includes various etiologies, including traumatic, iatrogenic, and spontaneous causes, each with distinct epidemiological and clinical characteristics. Case presentation: A 40-year-old Asian female presented with a three-month history of watery discharge from her left nostril and dull headaches localized to the left side of her head. Despite the initial diagnosis of allergic rhinitis, symptoms persisted, leading to further evaluation and eventual diagnosis of cerebrospinal fluid rhinorrhea. Detailed history, physical examination, and diagnostic tests including fluid analysis and imaging confirmed the diagnosis. The patient underwent a successful surgical repair after failed conservative management, highlighting the importance of timely intervention. Conclusion: Cerebrospinal fluid rhinorrhea poses significant risks if left untreated, including meningitis. Prompt recognition, accurate diagnosis, and individualized treatment strategies are crucial in mitigating complications and improving patient outcomes. A multidisciplinary approach, incorporating both conservative and surgical interventions tailored to the underlying cause, is essential for the successful management of cerebrospinal fluid rhinorrhea. [ABSTRACT FROM AUTHOR]

Background: Mesothelioma is an uncommon malignant tumor with variable clinical presentations, radiological features, and morphological patterns. Mesothelioma with predominantly intrapulmonary growth presents with an insidious onset, similar radiological and even morphological features to lung cancer, and poses a diagnostic pitfall. Case Presentation: Herein, we reported a 53-year-old female with biphasic mesothelioma misdiagnosed as poorly differentiated adenocarcinoma with focal sarcomatoid carcinoma. Computed tomography (CT) scan of the chest at the first visit revealed a solid lobulated nodule in the basal segment of the lower lobe of the right lung, which was suspicious of lung cancer. Microscopically, the tumor was composed of epithelioid and spindle cells, both of which were diffusely and strongly positive for CK7, and negative for TTF-1, Napsin A, P40, Melan A, S-100, SMA, and CD34. It was originally misdiagnosed as poorly differentiated adenocarcinoma with focal sarcomatoid carcinoma at initial presentation. Until her second admission with the discovery of a nodule in the right diaphragmatic angle, the peculiar location and biphasic component reminded us of biphasic mesothelioma. Immunohistochemically, tumor cells in both pulmonary and diaphragmatic nodules were positive for calretinin, D2-40, and WT-1, but negative for BerEP4 and MOC31. The patient was treated with a chemotherapy regimen of pemetrexed and carboplatin. After 11 months of follow-up, the patient recovers well without recurrence or metastasis. Conclusion: Mesothelioma with predominantly intrapulmonary growth is extremely rare and poses a diagnostic pitfall. For this entity, subtle morphological features, selection of immunohistochemical markers, and electron microscopy are of great significance for definite diagnosis. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Merkel cell carcinoma (MCC) is a rare and aggressive skin cancer that can be easily misdiagnosed in its early stages. Clinicians should maintain a high index of suspicion for rapidly growing skin lesions in elderly patients and promptly investigate with histopathology and immunohistochemistry. Treatment for MCC should be individualized, considering the patient's age, overall health, and quality of life. Close follow‐up is essential to detect recurrence or metastasis early. [ABSTRACT FROM AUTHOR]

ABSTRACT: Systemic lupus erythematosus (SLE) is a complex and multifaceted autoimmune disease that poses a significant diagnostic challenge for healthcare providers due to its diverse clinical manifestations, lack of specific testing, and potential to mimic other conditions. Delayed diagnosis and misdiagnosis of SLE can have serious consequences for patients, impacting their physical and psychological well-being. The physical consequences of delayed diagnosis and misdiagnosis of SLE are significant. Studies have shown that delays in diagnosis can lead to increased organ damage, poorer health outcomes, and increased morbidity and mortality. With a delayed diagnosis or misdiagnosis, patients may also experience increased psychological symptoms, such as depression, anxiety, and lack of trust in clinicians. The median delay from the first symptom to diagnosis in SLE is 47 months, highlighting the need for early recognition and management. Delayed diagnosis can lead to increased disease progression, which can result in irreversible organ damage and long-term complications. This paper investigates the multifaceted consequences of delayed diagnosis and misdiagnosis of SLE, encompassing both physical and psychological impacts. It delves into the underlying reasons behind diagnostic delays and offers comprehensive strategies for healthcare providers to enhance early recognition and management. Through a thorough analysis of medical literature and statistical data, this paper aims to provide physicians with actionable insights to improve diagnostic accuracy and patient outcomes in SLE. [ABSTRACT FROM AUTHOR]

Aim: The purpose of this study is to report diagnostic pearls and review the clinical presentation and outcomes of surgical treatment of paediatric trigger thumbs. Methods: A retrospective review of medical records and imaging studies was performed on children with trigger thumbs from January 2009 to December 2019. Results: Sixty‐four trigger thumbs in 52 consecutive patients were treated. The average age at referral was 2.5 years. Symptoms include pain (4), triggering (14) and fixed contracture (38). The average symptom duration was 8 months. Forty patients had been evaluated and referred by a paediatrician or primary care doctor. Twenty‐four of the 52 (46%) patients received hand x‐rays and were initially misdiagnosed as a fracture or dislocation. Physical exam demonstrated a volar nodule in 64 thumbs (100%), fixed flexion deformities in 38 (73%) thumbs and triggering with active extension of the interphalangeal joint in 14 (27%) thumbs. The average age at surgery was 3.2 years. Follow‐up averaged 12 months. Surgery resulted in complete relief of symptoms and correction of deformity. There was no reported loss of function or complication. Conclusions: Children with trigger thumbs who ultimately undergo surgery present with distinct physical exam findings, including a volar nodule and a fixed flexion contracture. Understanding these pearls can minimise misdiagnosis of the condition as a fracture or dislocation. Highlighting trigger thumbs during musculoskeletal education for paediatric and primary care physicians is recommended. Surgical outcomes were excellent in patients aged 2–8 years old. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To enhance your understanding of the stigma associated with personality disorders • To find out how the narrative around personality disorders is evolving • To recognise the need for comprehensive staff training and education about personality disorders. Individuals with a personality disorder diagnosis experience high levels of stigma within society generally and healthcare services specifically. This narrative review analyses the recent literature exploring the stigma associated with personality disorders. The findings offer insights into the ongoing contentious nature of personality disorder as a diagnosis, the issues around misdiagnosis and the prevailing attitudes of healthcare professionals. [ABSTRACT FROM AUTHOR]

Purpose of Review: Misdiagnosis of multiple sclerosis (MS) is a prevalent worldwide problem. This review discusses how MS misdiagnosis has evolved over time and focuses on contemporary challenges and potential strategies for its prevention. Recent Findings: Recent studies report cohorts with a range of misdiagnosis between 5 and 18%. Common disorders are frequently misdiagnosed as MS. Overreliance on MRI findings and misapplication of MS diagnostic criteria are often associated with misdiagnosis. Emerging imaging biomarkers, including the central vein sign and paramagnetic rim lesions, may aid diagnostic accuracy when evaluating patients for suspected MS. Summary: MS misdiagnosis can have harmful consequences for patients and healthcare systems. Further research is needed to better understand its causes. Concerted and novel educational efforts to ensure accurate and widespread implementation of MS diagnostic criteria remain an unmet need. The incorporation of diagnostic biomarkers highly specific for MS in the future may prevent misdiagnosis. [ABSTRACT FROM AUTHOR]

The coexistence of heart failure (HF) and type 2 diabetes mellitus (T2DM) is common and poses a serious threat to human health because these diseases have a high degree of commonality at the vascular level. However, the diagnosis of HF in primary care can be challenging, leading to the risk of inadequate management of both conditions. Using two case reports as examples, we attempt to shed light on the issues involved in this challenge. In the first case presentation, a 62-year-old male patient with T2DM and dyspnea was initially diagnosed with HF during primary care. However, further workup revealed that the actual cause of the patient's breathlessness was the exacerbation of chronic obstructive pulmonary disease. In the second case, a 59-year-old woman with T2DM and obesity complained of leg swelling that was attributed to chronic venous insufficiency by a primary care physician. A correct diagnosis of HF with preserved ejection fraction (HFpEF) was made using N-terminal pro-B-type natriuretic peptide and echocardiography. Due to diabetic vasculopathy HF is more likely to progress with a preserved ejection fraction. In addition, symptoms of COPD or obesity may overlap with or mask symptoms of HFpEF. The issues of over- and misdiagnosis of HFpEF in primary care are discussed in our review, which emphasizes the nonspecific nature of symptoms, such as breathlessness and leg edema in patients with type 2 diabetes mellitus. It is of utmost importance for healthcare providers to be aware of unusual manifestations of heart failure and, vice versa, of diseases that masquerade as heart failure. This will enable them to manage risks in these patients with greater consistency. [ABSTRACT FROM AUTHOR]

Abstract Background Anticoagulants increase the risk of cardiac tamponade in patients with pericardial effusion (PE). Therefore, inappropriate administration of them in the presence of PE can lead to a catastrophic outcome. This study presents a patient with a provisional misdiagnosis of venous thromboembolism (VTE). Case Presentation An 83-year-old Iranian female was transferred to the emergency department of a tertiary cardiology hospital complaining of neck swelling concomitant with chest pain and dyspnea. The patient had been diagnosed with jugular vein thrombosis in another local center, and since the chief complaint was neck swelling, she underwent Doppler sonography, and the diagnosis was confirmed. Subsequently, the treatment with unfractionated heparin was started. After 5 h, considering the worsening of symptoms with the suspicious diagnosis of COVID-19 based on her symptoms and laboratory data, a chest computed tomography scan was requested, which showed a massive PE. Subsequently, transthoracic echocardiography confirmed the diagnosis. The patient was immediately transferred to the operating room and underwent pericardiotomy. The post-surgery period was uneventful, and she was discharged 5 days later. Conclusion Patients with viral infections, specifically COVID-19, are at risk of undiagnosed severe pericardial effusions. Venous stasis in the jugular veins due to PE can mimic jugular vein thromboembolism, causing a wrong diagnosis. Since treating thrombosis can exacerbate tamponade to hemodynamic instability and collapse, sufficient investigation before starting anticoagulants is necessary. Clinical key message Distinguishing VTE from PE is not always straightforward. Therefore, it is important to ensure physicians have reached an appropriate level of certainty about their diagnosis by performing precise diagnostics before using anticoagulants. Mismanagement with anti-thrombotics can result in catastrophic consequences. Therefore, taking an accurate history, performing a precise physical examination, and using rapid and available diagnostic modalities can avoid delays in definitive management.

Abstract Background Chronic active Epstein-Barr virus (CAEBV) colitis is a rare disease with clinical and endoscopic manifestations very similar to those of inflammatory bowel disease (IBD). In clinical practice, it is easy to be misdiagnosed and mistreated, leading to poor clinical outcomes. Case presentation We report a case of a 56-year-old Chinese woman who presented with 6 years of intermittent severe diarrhea, fever, and abdominal pain. Ulcerative colitis was initially suspected. The patient’s clinical symptoms were partially relieved after treatment with mesalazine and probiotics. However, the symptoms were repeated and improved after supportive and symptomatic treatment each time. Colonoscopy revealed multiple mucosal erosion and edema in the colon, EBV-encoded small RNA 1/2 in situ hybridization in the pathological tissue of the colon was positive (20/HP), and EBVDNA in the peripheral blood was positive. CAEBV colitis was diagnosed. The patient was given dexamethasone and acyclovir, and she was improved after treatment. Unfortunately, she was discharged without outpatient follow-up, and similar symptoms recurred one year later, with similar colonoscopy and pathological examinations. Symptoms were relieved after dexamethasone treatment. Conclusion This case highlights the diagnostic challenges posed by nonspecific clinical manifestations of CAEBV colitis, which should be included as a differential diagnosis in patients with recurrent diarrhea and fever to avoid misdiagnosis.

ObjectiveTo analyze the clinicopathological features, diagnosis and differential diagnosis of bronchiolar adenoma (BA) with primary lung cancer. MethodsData of 17 BA patients complicated with primary lung cancer in Dalian University Affiliated Xinhua Hospital from January 2020 to December 2022 were collected, and the clinical data, histopathological features and immunohistochemical features were summarized. Results17 patients included 7 males and 10 females, with 49-82 years old. There were 2 squamous cell carcinoma and 15 adenocarcinoma. BA was mostly nodular, without capsule. It had a clear boundary with the surrounding lung tissue, with a major diameter of 0.3-1.5 cm. The section of BA was gray-white, gray-red, gray-brown, with medium-soft texture, and a few had obvious mucus. Microscopically, it was composed of luminal cell layer and basal cell layer, and luminal cells contain mucus cells, ciliated cells, cubic cells and columnar cells. According to the composition of luminal cells, BAs were divided into proximal type and distal type. There were 5 proximal type and 12 distal type, including 1 case of atypical distal BA. Immunohistochemistry results showed that in typical BAs, CK5/6, p63 and p40 were positive in basal cells, thyroid transcription factor-1 was positive in luminal cells and basal cells, and the proliferation index of Ki-67 was 1%. ConclusionsBA is a benign tumor, and is a bilayer structure mainly composed of luminal cells and basal cells. However, when the absence or discontinuity of basal cells, BA is easily misdiagnosed as malignancy, which should be highly vigilant.

Abstract Epithelioid sarcomas are rare soft tissue tumors and have possibility to involve the peripheral nerve and present as sensory and motor disorders. The symptoms are similar to those of nerve compression diseases. This situation is extremely rare in clinic and was only reported as several case reports in literature. It can be easily ignored and misdiagnosed in clinic and may bring out severe outcomes. From January 2003 to December 2017, a retrospective analysis of ten patients with epithelioid sarcomas which involved the peripheral nerves was made. The medical data, detailed clinical courses and the follow-up results were stated. In these cases, the tumors invaded the median nerve, ulnar nerve, radial nerve, brachial plexus, sciatic nerve and presented as relative symptoms. Early diagnosis and treatment are the keys to better prognosis. We recommended high-resolution ultrasound as a standard diagnostic tool for nerve compression syndromes not only reveal the morphological structure of the peripheral nerve, but also discover the tumor involving the nerve. Adequate surgical methods including wide resection and lymph node dissection if necessary. The manners of functional reconstruction need to be applied flexibly by the doctors. Postoperative rehabilitation is important for functional recovery. We want to share our experiences in the diagnosis and treatment to overcome this particular condition.

Abstract Introduction Although giant cystic pheochromocytoma and paraganglioma (PPGL) are uncommon, they can be life-threatening when it occurs. Unfortunately, prior case reports have shown that giant cystic PPGLs are highly susceptible to diagnostic errors. Therefore, this study aimed to explore giant cystic PPGLs by comparing them with non-cystic PPGLs, defining the clinical features of the affected patients, and analyzing the characteristics of misdiagnosis and mistreatment associated with PPGLs. The goal is to provide insights for the timely and accurate diagnosis and treatment of giant cystic PPGLs. Methods A total of 170 cases of pheochromocytoma and paraganglioma (PPGL) diagnosed at the First Affiliated Hospital of Chongqing Medical University from April 2011 to April 2020 were confirmed through clinical evaluation, measurement of catecholamine metabolites, imaging studies, or surgical pathology. The patients were classified into two groups based on the maximum tumor diameter and the presence of cystic components. The clinical characteristics of patients in the giant cystic group, including timely diagnosis and instances of misdiagnosis, are summarized. Additionally, the differences in demographics, clinical manifestations, laboratory examinations, imaging features, treatment approaches, and tumor characteristics between the two groups were analyzed. Results Among the 17 patients in the giant cystic group, eight (47.1%) patients were misdiagnosed. The misdiagnosis and mistreatment characteristics of PPGLs were as follows: female (50%); median age, 51 years; normal blood pressure; greater mass effect at onset; larger tumors; median time to diagnosis extension, 180 days; and misdiagnosed disease, which was mainly tumors of adjacent organs, the digestive system, the cardiovascular system, the urinary system, the nervous system, or the endocrine system. The giant cystic group had greater mass effects than did the non-cystic group (P

Systemic lupus erythematosus (SLE) is a complex and multifaceted autoimmune disease that poses a significant diagnostic challenge for healthcare providers due to its diverse clinical manifestations, lack of specific testing, and potential to mimic other conditions. Delayed diagnosis and misdiagnosis of SLE can have serious consequences for patients, impacting their physical and psychological well-being. The physical consequences of delayed diagnosis and misdiagnosis of SLE are significant. Studies have shown that delays in diagnosis can lead to increased organ damage, poorer health outcomes, and increased morbidity and mortality. With a delayed diagnosis or misdiagnosis, patients may also experience increased psychological symptoms, such as depression, anxiety, and lack of trust in clinicians. The median delay from the first symptom to diagnosis in SLE is 47 months, highlighting the need for early recognition and management. Delayed diagnosis can lead to increased disease progression, which can result in irreversible organ damage and long-term complications. This paper investigates the multifaceted consequences of delayed diagnosis and misdiagnosis of SLE, encompassing both physical and psychological impacts. It delves into the underlying reasons behind diagnostic delays and offers comprehensive strategies for healthcare providers to enhance early recognition and management. Through a thorough analysis of medical literature and statistical data, this paper aims to provide physicians with actionable insights to improve diagnostic accuracy and patient outcomes in SLE.

Abstract Background During embryogenesis, the spleen undergoes intricate developmental processes, originating from mesenchymal cells in the dorsal mesentery. An accessory spleen, a common anomaly found in autopsies and abdominal CT scans, can often be mistaken for different types of tumors. To the best of our knowledge, this is the first case in Syria documenting the occurrence of 3 accessory spleens in a patient who had previously undergone splenectomy. Case presentation A 33-year-old male presented with right hypochondrium pain, sharp and radiating to the right flank, exacerbated by movement and large meals. Past medical history included mild Irritable Bowel Syndrome (IBS) and splenectomy due to a traumatic accident in childhood. On admission, vital signs were stable, with abdominal tenderness in the right upper quadrant. Laboratory investigations showed normal values. Ultrasound revealed a lobulated mass at the right adrenal gland (4.5 × 5 cm) with an isoechoic to hypoechoic texture. Multi-slice computed tomography (MSCT) Scan showed multiple nodules in the right adrenal gland, regular in shape, exerting a compressive mass effect, and significant lymphadenopathy around the abdominal aorta. Elevated metanephrine levels raised suspicion of an extra-adrenal pheochromocytoma. Laparoscopic surgery was performed, revealing accessory spleens and normal adrenal tissue with no malignancy. Conclusion Healthcare providers should consider accessory spleens as a differential diagnosis for masses near the adrenal glands. Multiple accessory spleens in the adrenal region can complicate cases. Accessory spleens in uncommon locations like the adrenal glands can be challenging to diagnose and manage.

Abstract Background Cerebrospinal fluid rhinorrhea is a rare condition characterized by the abnormal leakage of cerebrospinal fluid from the intracranial space into the sinonasal cavity. It includes various etiologies, including traumatic, iatrogenic, and spontaneous causes, each with distinct epidemiological and clinical characteristics. Case presentation A 40-year-old Asian female presented with a three-month history of watery discharge from her left nostril and dull headaches localized to the left side of her head. Despite the initial diagnosis of allergic rhinitis, symptoms persisted, leading to further evaluation and eventual diagnosis of cerebrospinal fluid rhinorrhea. Detailed history, physical examination, and diagnostic tests including fluid analysis and imaging confirmed the diagnosis. The patient underwent a successful surgical repair after failed conservative management, highlighting the importance of timely intervention. Conclusion Cerebrospinal fluid rhinorrhea poses significant risks if left untreated, including meningitis. Prompt recognition, accurate diagnosis, and individualized treatment strategies are crucial in mitigating complications and improving patient outcomes. A multidisciplinary approach, incorporating both conservative and surgical interventions tailored to the underlying cause, is essential for the successful management of cerebrospinal fluid rhinorrhea.

Background Although the number of case reports on pulmonary infarction (PI) secondary to pulmonary embolism (PE) is increasing in recent years, its misdiagnosis remains common, mainly as pneumonia. In patients with intermediate and high-risk pulmonary embolism, delays in diagnosis and timely treatment would lead to poor prognosis. Objective By analyzing the pneumonia-misdiagnosed cases of patients with PI, we summarized their clinical characteristics and related risk factors, and constructed a multivariate joint model to improve the accurate diagnosis rate at early stage. Methods This retrospective study included the hospitalized patients with pulmonary embolism at the First Affiliated Hospital of USTC from January 2017 to December 2023. In the group of pneumonia-misdiagnosed patients with intermediate to high-risk PI, we analyzed the clinical characteristics and compared the differences between the misdiagnosed groups and control group. Furthermore, using a multivariate Logistic regression analysis, we explored the independent predictive factors of the delayed diagnosis, analyze the predictive value of various indicators for the misdiagnosis by ROC curves, and compared the AUC values using Delong test. Results Among 101 cases of PI patients, 70 of them were misdiagnosed as pneumonia. From 2017 to 2023, the misdiagnosis rate gradually decreased in percentages of 100.0%, 83.3%, 74.1%, 71.4%, 63.2%, 66.7%, and 50.0%, respectively (χ2trend=6.672, P=0.010). Based on the results of multivariate Logistic regression analysis, the characteristics of over sixty-years-old age (OR=18.271, 95%CI=4.373-76.339, P

Abstract Background Heart failure is a clinical syndrome characterized by decreased cardiac output, leading to systemic organ hypoxia and resulting in dyspnea, pulmonary edema, organ congestion, and pleural effusion. Owing to the diverse clinical manifestations of heart failure, early diagnosis can be challenging, and misdiagnosis may occur occasionally. The use of echocardiography and blood brain natriuretic peptide can aid in obtaining a more accurate diagnosis. Case presentation This article presents two case reports of patients who were misdiagnosed with acute cholecystitis. Both patients were young Mongolia males (age 26 and 39 years) who presented to the emergency department with acute upper abdominal pain, abdominal ultrasound revealed gallbladder enlargement, and blood tests suggested mild elevation of bilirubin levels. However, despite the absence of procalcitonin and C-reactive protein elevation, the patients were admitted to the general surgical department with a diagnosis of “acute cholecystitis.” Both patients were given treatment for cholecystitis, but their vital signs did not improve, while later examinations confirmed heart failure. After treatment with diuretics and cardiac glycosides, both patients’ symptoms were relieved. Conclusion We aim to highlight the clinical manifestations of heart failure and differentiate it from rare conditions such as acute cholecystitis. Physicians should make accurate diagnoses on the basis of physical examinations, laboratory testing and imaging, and surveys while avoiding diagnostic heuristics or mindsets. By sharing these two case reports, we hope to increase awareness to prevent potential complications and improve patient outcomes.

Neurocysticercosis (NCC), a parasitic infection of the central nervous system caused by the larval stage of Taenia solium, presents a diagnostic conundrum due to its rare and often nonspecific clinical manifestations. This paper aims to unravel the diagnostic mystery surrounding NCC, shedding light on its epidemiology, pathophysiology, clinical presentation, and the challenges encountered in its diagnosis. Despite being considered a rare disease, NCC is the leading cause of acquired epilepsy worldwide, underscoring its clinical significance. The complexity of NCC diagnosis lies in its diverse clinical presentations, which can range from headaches, dizziness, and seizures to more severe neurological cognitive deficits. This diversity often leads to misdiagnosis. Furthermore, the limitations of current diagnostic methods, including serological tests and neuroimaging, contribute to the diagnostic dilemma. This paper emphasises the need for improved diagnostic criteria and novel diagnostic tools to enable early and accurate detection of NCC. By enhancing our understanding of NCC, we can pave the way for better management strategies, ultimately improving patient outcomes in this under-recognised disease.

Background: Heart failure is a clinical syndrome characterized by decreased cardiac output, leading to systemic organ hypoxia and resulting in dyspnea, pulmonary edema, organ congestion, and pleural effusion. Owing to the diverse clinical manifestations of heart failure, early diagnosis can be challenging, and misdiagnosis may occur occasionally. The use of echocardiography and blood brain natriuretic peptide can aid in obtaining a more accurate diagnosis. Case presentation: This article presents two case reports of patients who were misdiagnosed with acute cholecystitis. Both patients were young Mongolia males (age 26 and 39 years) who presented to the emergency department with acute upper abdominal pain, abdominal ultrasound revealed gallbladder enlargement, and blood tests suggested mild elevation of bilirubin levels. However, despite the absence of procalcitonin and C-reactive protein elevation, the patients were admitted to the general surgical department with a diagnosis of "acute cholecystitis." Both patients were given treatment for cholecystitis, but their vital signs did not improve, while later examinations confirmed heart failure. After treatment with diuretics and cardiac glycosides, both patients' symptoms were relieved. Conclusion: We aim to highlight the clinical manifestations of heart failure and differentiate it from rare conditions such as acute cholecystitis. Physicians should make accurate diagnoses on the basis of physical examinations, laboratory testing and imaging, and surveys while avoiding diagnostic heuristics or mindsets. By sharing these two case reports, we hope to increase awareness to prevent potential complications and improve patient outcomes. [ABSTRACT FROM AUTHOR]

Our goal for medicine is to make zero mistakes, yet the reality is that mistakes are an unfortunate part of medical practice. And when it comes to surgical pathology, it is a special case where the diagnostic "bottom line" is provided starkly and directly for all to see in the final diagnosis of the pathology report. When this diagnosis is wrong, particularly when it has serious adverse consequences for the patient, the resulting physical, mental, and emotional effects on patient, provider, pathologist, and health care system can be extremely serious. Head and neck surgical pathology, based on large second review-type studies, is a subspecialty area with average rates of major diagnostic error, but with potential for severely negative impacts on patients. Studies have shown between 1% and 7% major error rates for head and neck practice. How then, as the pathologist, can we react to and manage things when we have made a serious diagnostic mistake? Through personal experience over more than two decades, the hard-won answer is through extreme ownership and a focus on the needs of the patients, who, in the words of William J. Mayo, should have their "needs come first". The emotional impact on us as pathologists and on the clinicians we work with should also be acknowledged and managed. This article will serve as a thorough and open examination of these mistake scenarios and, focusing specifically on diagnostic errors, serve as a practical guide for what you can do, moving forward, to "make things right" to the best of your ability. [ABSTRACT FROM AUTHOR]

I argue that the recurring practice of self-diagnosis of psychiatric conditions such as autism spectrum disorder and attention-deficit/hyperactivity disorder on social media platforms poses a threat to personal autonomy understood as self-governance. My main argument is that self-diagnosis conducted without professional expertise is prone to lead to misdiagnosis, which can take the form of a distortion of self-image. This may result in pathologizing normal experiences and behaviors and the adoption of behavioral adjustments that harm those who engage in self-diagnosis. Acknowledging that the surge of self-diagnosis content is a response to inadequacies of mental health care systems in many parts of the world, I argue against prohibiting such content and end with a more modest suggestion of implementing warnings alongside it on social media platforms, as is already common practice for misinformation content on diseases like Covid-19. [ABSTRACT FROM AUTHOR]

Background: Self-medication has grown increasingly in developing countries, such as India, perhaps causing drug addiction and microbial resistance. Without proper medical supervision, self-medication can cause ineffective or excessive treatment, a delay in treatment, misdiagnosis, resistance to antibiotics, medicine abuse, and an increase in morbidity. Methodology: The population-based crosssectional analytical research done in urban slum. We questioned 400 individuals over the age of 18 at their homes. Data were acquired from individuals using a predesigned, pretested questionnaire as an interview tool. Objective: To determine self medication prevalence and its connection to various demographic risk factors. Results: Self-medication was prevalent, with 51% in selected urban slums. The most commonly self-administered drugs were analgesics (59.8%) and antacids (46.07%). Body discomfort (60.29%), Headaches (55.78%), feverish (53.43%), cough (41.01%), were among the most common conditions when participants used medication on their own. There was a significant relationship with self-prescribed medication use and healthcare professionals in the household (p = 0.00001) and among working participants (p = 0.009). Conclusion: Lower socioeconomic groups often use medications without consulting doctors, and chronic illnesses require continuous follow-up. Education on the dangers of self-medication is crucial. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to analyze the clinical characteristics and outcomes of patients with primary dumbbell chordoma of the cervical spine and to summarize the causes of misdiagnosis. Methods: The clinical data of patients were retrospectively collected. The diagnostic process, surgical procedures, and outcomes were analyzed, then the difference was compared between dumbbell and non‐dumbbell chordomas of the cervical spine. Results: This study included six patients with primary dumbbell chordoma (one male and five females) with a mean age of 32.2 ± 24.5 years (range: 5–61 years). Five cases with no computed tomography (CT) examination before the first operation were misdiagnosed, and on magnetic resonance imaging (MRI), primary dumbbell chordoma showed the following specific features: extensive invasion of the surrounding soft tissues with an obscure boundary (≥5 cm), intervertebral disc sparing, and hemorrhagic necrosis, furthermore, the CT features included atypical destructive vertebral lesions, minimal intralesional calcification, and neural foraminal enlargement. After comparison with non‐dumbbell chordomas, it show statistical difference (p < 0.05) in terms of calcification, foramen enlargement, FNA, misdiagnosis rate but with different recurrent rate. Conclusion: Primary dumbbell chordomas of the cervical spine can easily be misdiagnosed as neurogenic tumors. Preoperative CT‐guided fine‐needle aspiration puncture biopsy helps make an accurate diagnosis. Gross total excision with postoperative radiotherapy has been proven effective in reducing the recurrence rate. [ABSTRACT FROM AUTHOR]

Background: Multiple sclerosis (MS) misdiagnosis is common, and when discovered, frequently leads to substantial disruption to patients' lives and anxiety for clinicians. Our objective was to develop expert consensus‐based guidelines about how to communicate a misdiagnosis of MS to a patient, to reduce the potential for both psychological distress and litigation. Methods: A modified Delphi method using a systematic literature review on doctor and patient experiences of the MS diagnosis communication was used to populate items for a first‐round questionnaire. Our Delphi panel represented three perspectives (clinicians, people with MS, and published experts in health communication), and we recruited 18 panelists in total (6 per perspective). Consensus was defined a priori as 75% of panelists giving an item the same rating. A feedback round was undertaken with six external reviewers, naïve to the guideline development process, and the panelists. Items were reviewed by the study team and synthesized to create the finalized guidelines. Results: Consensus was reached for 45 items rated as "very important" and presented in the feedback round. The study team synthesized the 45 items to 27 items. Ten items related specifically to the communication of the MS misdiagnosis and 17 items to generic guidelines highlighted as important in the MS misdiagnosis appointment. Seven recommendations form the guidelines presented here. Conclusions: Seven consensus‐based recommendations offer guidance to practising neurologists in their communication with patients in a situation that has the potential to be highly distressing, for both clinician and patient. [ABSTRACT FROM AUTHOR]

Background: Diagnostic errors in multiple sclerosis (MS) impact patients and healthcare systems. Objectives: This study aimed to determine the prevalence of MS misdiagnosis and underdiagnosis, time delay in reaching a correct diagnosis and potential impact of sex. Methods: Systematic review and meta-analysis on MS diagnostic errors. Results: Out of 3910 studies, we included 62 for a qualitative synthesis and 24 for meta-analyses. Frequency of misdiagnosis (incorrect assignment of an MS diagnosis) ranged from 5% to 41%, with a pooled proportion based on six studies of 15% (95% CI: 9%–26%, n = 1621). The delay to rectify a misdiagnosis ranged from 0.3 to 15.9 years. Conversely, underdiagnosis (unrecognized diagnosis of MS) ranged from 3% to 58%, with a pooled proportion in four studies of 36% (95% CI: 20%–55%, n = 728). Pooling seven studies comprising 2851 individuals suggested a diagnostic delay to establish a correct MS diagnosis of 17.3 months (95% CI: 11.9–22.7) in patients underdiagnosed. In a meta-analysis of five studies, women were 2.1 times more likely to be misdiagnosed with MS compared to men (odds ratio, 95% CI: 1.53–2.86). Conclusion: This study provides summary-level evidence for the high prevalence of MS misdiagnosis and underdiagnosis. Future studies are needed to understand the causes of these diagnostic challenges in MS care. [ABSTRACT FROM AUTHOR]