Cognitive Biases to Consider in Non-convulsive Status Epilepticus Presenting in a Hematologic Malignancy

By Katherine M. Sawicka, Derek MacFadden & Victoria A. McCredie
First Online: 10 August 2020

Non-convulsive status epilepticus (NCSE) is a common clinical problem encountered in neurocritical care. The differential diagnosis for NCSE is broad, and first-line investigations including routine cerebrospinal (CSF) analysis, electroencephalography (EEG), and magnetic resonance imaging (MRI) of the brain may be non-specific and not necessarily narrow the differential diagnosis. For these reasons, patients with NCSE can be difficult cases for trainees in terms of diagnosis and management. Furthermore, when patients have complex or rare comorbidities, the presence of such may influence the clinician to anchor subsequent decisions based on these prior probabilities. As clinicians, we must remain mindful of cognitive biases that may impact diagnostic and management decisions. We present a patient with a known rare hematologic malignancy presenting with presumed sepsis and NCSE. This case serves as an example where anchoring, confirmation bias, and base-rate fallacy had the potential to distort judgment; however, by keeping a broad differential diagnosis a definitive diagnosis was reached, albeit postmortem.

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