Neurology is the specialty where diagnostic delay costs the most, and where over-diagnosis costs too. One migraine in four is not recognised as such, 17 to 19 percent of patients referred to a specialist centre with an established multiple sclerosis diagnosis do not have it, and most memory complaints never become dementia. The three figures describe one problem: a clinical examination replaced by an image.
The questions we get asked
Is an MRI needed for headache?
When the neurological examination is normal, the probability of finding a significant lesion on MRI in a patient with migraine is 0.9 percent. Thirty-seven scans are needed to produce one incidental finding, and most of those findings do not change management. Imaging is justified by a red flag, not by a typical headache.
How long does a wrong neurological diagnosis last?
In the case series published by Solomon in 2016, 33 percent of patients carrying a wrong multiple sclerosis diagnosis had carried it for ten years or more. The cost is not only psychological: roughly 110 patient-years of unnecessary disease-modifying therapy were estimated across the two Kaisey cohorts.
Does a memory complaint announce dementia?
In community samples, mild cognitive impairment converts to dementia at about 2.33 percent per year. It also reverts to normal cognition in 14 percent of clinic cohorts and 31 percent of community cohorts. A single assessment does not make a prognosis.
What can a second opinion add?
Re-reading the existing MRI sequences, taking the clinical history again, and checking which criteria were actually applied. That is precisely what the centres behind the figures above do.
What the figures say
| Finding | Figure | Source |
|---|---|---|
| Significant MRI lesion, migraine with a normal examination | 0.9 percent | Sempere et al., 2005 |
| Scans needed for one incidental finding | 37 | Morris et al., BMJ, 2009 |
| MS diagnosis not confirmed on review | 17 to 19 percent | Kaisey et al., 2019 |
| Error carried for 10 years or more | 33 percent | Solomon et al., Neurology, 2016 |
| Conversion of mild cognitive impairment to dementia | 2.33 percent per year | Mitchell and Shiri-Feshki, 2014 |
What Noria Health does, and does not do
We organise a neurology consultation and, where relevant, a review of existing imaging with a specialist team near Brussels. Feasibility is confirmed within 24 to 48 hours, and follow-up is documented at D14, D30 and D90.
We do not make any diagnosis remotely, we do not comment on a treatment already in progress, and we never advise stopping a medication.
Who reviewed this page
Noria Health editorial team.
Our neurology articles
- Migraine: 0.9% of MRIs show a lesion when the examination is normal
- Multiple sclerosis: what misdiagnosis teaches us
- Memory complaints: what the figures actually say
- Neurology, 1 migraine in 4 may go unrecognised
Have your case reviewed. Noria Health arranges a specialist consultation near Brussels and confirms feasibility within 24 to 48 hours. Open a case.