{
  "abstract": "When persistent neurological symptoms and signs defy diagnostic explanation despite repeated rounds of investigation, how should the clinician proceed? We present a case of this type with an eventual and unusual diagnosis. As well as being an exercise in awareness raising, the case serves as a prelude to considering what practical management strategies might be adopted in the face of persistent diagnostic uncertainty with its consequent frustrations for patient, significant others and physicians. We consider these approaches first with respect to the specific finding of ophthalmoplegia, the principal feature in this case, and second with respect to any neurological diagnosis.",
  "authors": [
    {
      "affiliations": [
        "Liverpool Interdisciplinary Neuroscience Centre, University of Liverpool, Liverpool, UK",
        "Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK",
        "Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK",
        "Neurology Department, The Walton Centre NHS Foundation Trust, Liverpool, UK"
      ],
      "name": "Gashirai K Mbizvo"
    },
    {
      "affiliations": [
        "Ophthalmology Department, Liverpool University Hospitals NHS Foundation Trust, Liverpool, England, UK"
      ],
      "name": "Anna Visca"
    },
    {
      "affiliations": [
        "Ophthalmology Department, Liverpool University Hospitals NHS Foundation Trust, Liverpool, England, UK"
      ],
      "name": "Ian Marsh"
    },
    {
      "affiliations": [
        "Neuroradiology Department, The Walton Centre NHS Foundation Trust, Liverpool, England, UK"
      ],
      "name": "Mark Radon"
    },
    {
      "affiliations": [
        "Neurology Department, The Walton Centre NHS Foundation Trust, Liverpool, UK"
      ],
      "name": "Dinesh Damodaran"
    },
    {
      "affiliations": [
        "Department of Translational Neuroscience & Stroke, University College London Queen Square Institute of Neurology, London, England, UK"
      ],
      "name": "Andrew J Larner"
    }
  ],
  "title": "Ophthalmoplegia: when the tests are all negative, where next?",
  "uid": "bc8282c8-6461-51a4-b282-f4c017711fad"
}