Diagnosis of exclusion
A diagnosis of exclusion (per exclusionem) is a diagnosis of a medical condition reached by a process of elimination, which may be necessary if presence cannot be established with complete confidence from history, examination or testing. Such elimination of other reasonable possibilities is a major component in performing a differential diagnosis.
The largest category of diagnosis by exclusion is seen among psychiatric disorders where the presence of physical or organic disease must be excluded as a prerequisite for making a functional diagnosis. Diagnosis by exclusion tends to occur where scientific knowledge is scarce, specifically where the means to verify a diagnosis by an objective method is absent. As a specific diagnosis cannot be confirmed, a fall back position is to exclude that group of known causes that may cause a similar clinical presentation.
An example of such a diagnosis is "fever of unknown origin": to explain the cause of elevated temperature the most common causes of unexplained fever (infection, neoplasm, or collagen vascular disease) must be ruled out.
Other examples include:
- Behcet's Disease
- Bell's Palsy
- Tolosa-Hunt syndrome
- Irritable bowel syndrome
- New daily persistent headache[medical citation needed]
- Sudden infant death syndrome[medical citation needed]
- Burning mouth syndrome.
- "Behcet Disease: Overview - eMedicine Dermatology". Retrieved 2009-03-28.
- Petruzzelli GJ, Hirsch BE (August 1991). "Bell's palsy. A diagnosis of exclusion". Postgrad Med 90 (2): 115–8, 121–2, 125–7. PMID 1862038.
- Freudenreich, O (December 2012). "Differential Diagnosis of Psychotic Symptoms: Medical "Mimics"". Psychiatric Times.
- Kwan ES, Wolpert SM, Hedges TR, Laucella M (February 1988). "Tolosa-Hunt syndrome revisited: not necessarily a diagnosis of exclusion". AJR Am J Roentgenol 150 (2): 413–8. doi:10.2214/ajr.150.2.413. PMID 3257334.
- Cash BD, Chey WD (June 2004). "Irritable bowel syndrome - an evidence-based approach to diagnosis". Aliment. Pharmacol. Ther. 19 (12): 1235–45. doi:10.1111/j.1365-2036.2004.02001.x. PMID 15191504.
- Cash BD, Chey WD (December 2003). "Advances in the management of irritable bowel syndrome". Curr Gastroenterol Rep 5 (6): 468–75. doi:10.1007/s11894-003-0035-5. PMID 14602054.
- Maltsman-Tseikhin, A; Moricca, P; Niv, D (June 2007). "Burning mouth syndrome: will better understanding yield better management?". Pain practice : the official journal of World Institute of Pain 7 (2): 151–62. doi:10.1111/j.1533-2500.2007.00124.x. PMID 17559486.