When scans failed, a cough spoke: How Hyderabad-based neurologist diagnosed a 55-year-old’s ‘silent’ spinal disease

Mon Apr 06 15:30:37 UTC 2026: ### Missed Diagnosis Highlights the Importance of Clinical Reasoning in Medicine

The Story:

A recent case shared by Hyderabad-based neurologist Dr. Sudhir Kumar underscores the critical role of careful listening and clinical reasoning in medical diagnosis. The case involved a 55-year-old man suffering from severe back pain for four months. Despite multiple tests, including blood work, nerve conduction studies, and MRI scans of the neck and lower back, the cause of his pain remained elusive. The patient had consulted multiple doctors and undergone various treatments without relief. Dr. Kumar’s intervention came when the patient consulted him online and mentioned the pain was in the mid-back and worsened with coughing and deep breathing, prompting a targeted MRI of the dorsal spine that revealed spinal tuberculosis.

Key Points:

• A 55-year-old man experienced severe back pain for four months despite normal initial tests (blood tests, nerve conduction studies, MRI of neck and lower back).
• Local doctors prescribed painkillers, muscle relaxants, and rest, which provided no relief.
• Dr. Sudhir Kumar diagnosed spinal tuberculosis after the patient mentioned the pain was in the mid-back and increased with coughing and deep breathing.
• An MRI of the dorsal (thoracic) spine revealed the diagnosis, as previous scans had focused on the wrong area.
• The patient had no typical TB symptoms like fever or weight loss.
• Dr. Kumar emphasized the importance of clinical reasoning and symptom analysis over relying solely on tests.
• Dr. Palleti Siva Karthik Reddy stressed the importance of revisiting clinical history and considering advanced imaging when pain persists despite normal initial investigations.

Key Takeaways:

• Careful listening to patients and thorough symptom analysis are crucial for accurate diagnosis, especially when initial tests are inconclusive.
• Targeted imaging is essential; scanning the wrong area can lead to missed diagnoses, even with advanced technology.
• Clinical reasoning and critical thinking should guide medical practice, not blind reliance on test results.
• Persistent pain, especially when localized or triggered by specific actions like coughing or breathing, warrants expert evaluation and further investigation.
• Patients should actively track and communicate their symptoms, including location, triggers, and associated symptoms, to aid in diagnosis.

  Read More