title: Lesson From a Case of Cervical Meningioma Misdiagnosed as Parkinsonism.
abstract: BACKGROUND
  Lesion localization based on patient's manifestation is a fundamental step in making a neurological diagnosis. However, it has been reported that diagnosticians are vulnerable to the effects of various cognitive biases during diagnostic processes.
  
  
  METHODS
  A 69-year-old man with right-hand stiffness visited the Movement Disorder Clinic with the history of periodic limb movement syndrome and restless leg syndrome. His sensory and deep tendon reflex examination results were normal. Brain magnetic resonance imaging was normal. Corticobasal degeneration was considered as a possibility, but functional imaging studies including FP-CIT positron emission tomography were all normal. Later, cervical spine magnetic resonance imaging revealed a cervical meningioma at the C2-C3 levels and he showed tingling senses in his right ulnar 3 fingers and a hyperactive knee jerk on his right side, which were absent on the first examinations.
  
  
  CONCLUSIONS
  Insufficient clinical information (declarative shortcoming) and inherent heuristic pitfalls (procedural shortcoming) were 2 major causes of the diagnostic error. Especially, in the present case, cognitive biases from framing effects and anchoring heuristics misled the clinical reasoning during the process of localization.
authors.affiliation: Department of Neurology, College of Medicine, Seoul National University, Seoul, Republic of Korea.
authors.forename: Chang Hyun
authors.initials: CH
authors.lastname: Nam
authors.forename: Beomseok
authors.initials: B
authors.lastname: Jeon
mesh_terms: D000368:Aged; D001921:Brain / Q000473:pathology; D002574:Cervical Vertebrae / Q000473:pathology; D003951:Diagnostic Errors; D006801:Humans; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D008577:Meningeal Neoplasms / Q000175:diagnosis*; D008579:Meningioma / Q000175:diagnosis*; D020734:Parkinsonian Disorders / Q000503:physiopathology*; D049268:Positron-Emission Tomography; D020891:Raclopride / Q000493:pharmacokinetics
chemical_list: D020891:Raclopride