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March 19, 2012

What's Your Medical Diagnosis? 90y, Female, unilateral ptosis

The Isabel tool touts an extensive database of conditions for differential diagnosis support, and we often will test its accuracy with real patient cases from the New England Journal of Medicine.

About the Isabel Diagnosis Challenge

The New England Journal of Medicine (NEJM) publishes interesting presentations of common diseases and unusual cases in the Clinical pathology Conference (CPC) series. These cases are educational and can pose diagnostic challenges even to the expert physicians at the Massachusetts General Hospital.

New England Journal of MedicineUsing the clinical features of these cases you can evaluate your own diagnostic skills and compare your diagnostic performance to that of the physicians at MGH. If you are registered with Isabel as a client or have a free-trial subscription, you can use the diagnosis reminder system and run through some scenarios to get a list of likely suspects. Clicking on a diagnosis will take you through to various knowledge sources and links available from within Isabel.

Today's Case

Demographic: Female, 90 yrs, North America
Clinical features:

  • ptosis
  • high white cell count
  • dysphagia
  • hoarseness
  • general fatigue
  • dysarthria
  • head drop
  • respiratory failure
  • mediastinal widening


Before you read further, construct your own:

  • Complete differential diagnosis
  • Final diagnosis

Differential Diagnoses considered by the MGH panel:
Cavernous carotid aneurysm

Final Diagnosis of the case according to NEJM:
(i) Thymoma (ii)Paraneoplastic myasthenia gravis

Differential Diagnoses of the case as given by Isabel:
Cavernous carotid aneurysm under Arterial aneurysms in Vascular

Was the final diagnosis given by Isabel:

Yes. 1) Thymoma under Thymic Neoplasms in Respiratory and 2) Myasthenia Gravis in Neuromuscular

NEJM case 39















Full case: NEJM case 39

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