A new case for Inspector Holmders: a cerebral image after a medical action



A 43 year-old man was under medical study after a lump was detected on his lung. During the diagnostic process, he started with headache ,disorientation and low level of consciousness. Physical  examination was difficult . A CAT scan without contrast was considered normal. A neurologist examined the patient and he made a decision…

CLINICAL EVOLUTION: The patient was unconscious, but in the physical examination the neurologist detected some impairment on the movement of his right arm and leg. He related the problem of the patient with a cerebrovascular event based on the acute onset and the impairment of movement on his right side.

This is the CAT scan of the patient:

hemotacprimero (1)
First CAT scan without contrast

CLINICAL EVOLUTION: The neurologist started specific treatment for the ischemic cerebrovascular accident under his clinical judgment
. This is the second CAT scan without contrast:





  1. What action do you think decided the neurologist?
  2. What type of cognitive bias can be recognized?

You can send your answer to: Foro Osler, email: ljalonso@uma.es

SOLUTION: The neurologist thought that the patient could have an ischemic cerebrovascular accident and he started fibrinolytic treatment and some hemorrhagic spots appeared. A new CAT scan with contrast revealed the presence of cerebral metastases.

ANALYSIS : Representation heuristic. The neurologist saw a patient with an acute clinical situation of disorientation, agitation and some impairment on the movement of his right arm and leg and he recognized a pattern of a cerebrovascular accident.