diagnostics-report.md

Day 1 : Diagnostics Pathway Analysis

Prompt

GPT Test-Subject-3's 3rd Pass was shared with an unaware Claude without context, it acted on the embedded Next Steps prompt without prompting.

Concept Map

graph TB
    subgraph Findings["Key Findings"]
        N[Neurological]
        V[Vascular]
        S[Systemic]
    end

    subgraph Neurological["Neurological Findings"]
        N --> N1[Progressive bilateral LRPN]
        N --> N2[Severe denervation]
        N --> N3[Atypical pain pattern]
    end

    subgraph Vascular["Vascular Findings"]
        V --> V1[CTA: Lack of arterial inflow]
        V --> V2[Doppler: Normal flow]
        V --> V3[Possible embolic phenomena]
    end

    subgraph Systemic["Systemic Findings"]
        S --> S1[Matched OGBs]
        S --> S2[Elevated CSF protein]
        S --> S3[PET: No active vasculitis]
    end

    subgraph Hypotheses["Diagnostic Hypotheses"]
        H1[Autoimmune Process]
        H2[Paraneoplastic Syndrome]
        H3[Embolic-Vascular]
    end

    subgraph Actions["Required Actions"]
        A1[Autoimmune Panel]
        A2[Paraneoplastic Screen]
        A3[Colonoscopy]
        A4[Thrombophilia Studies]
    end

    N1 & N2 & N3 --> H1
    S1 & S2 --> H1
    S1 & S2 & S3 --> H2
    V1 & V3 --> H3

    H1 --> A1
    H2 --> A2 & A3
    H3 --> A4

    style Findings fill:#f9f,stroke:#333
    style Hypotheses fill:#bbf,stroke:#333
    style Actions fill:#bfb,stroke:#333

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Meta

This visualization maps the complex relationships between findings, working hypotheses, and recommended actions. Key observations:

1. The diagram shows how multiple findings across different systems (neurological, vascular, systemic) contribute to each diagnostic hypothesis.

2. Critical pathways emerge:

   • Neurological and systemic findings strongly suggest autoimmune processes
   • Systemic findings point toward possible paraneoplastic syndrome
   • Vascular findings indicate potential embolic contributions

3. Each hypothesis leads to specific recommended actions for further investigation.

Next-Steps-Prompt

Would you like me to modify any aspects of the diagram or create additional visualizations focusing on specific aspects of the analysis?​​​​​​​​​​​​​​​​

Additional Visualisations

Temporal Progression of Findings

gantt
    title Disease Progression Timeline
    dateFormat  YYYY-MM
    axisFormat %Y-%m
    
    section Neurological
    MRI LS (DDD, no compression)      :2023-06, 1M
    Initial NCS (Left LRPN)           :2023-10, 1M
    Repeat NCS (Progressive)          :2024-07, 1M
    Final NCS (Bilateral LRPN)        :2025-01, 1M

    section Vascular
    CTA (↓ arterial flow)             :2024-12, 1M
    USS Doppler (normal flow)         :2024-12, 1M

    section Systemic
    First LP (Matched OGBs)           :2024-07, 1M
    Second LP (↑↑ Protein)            :2024-12, 1M
    PET Scan                          :2025-01, 1M

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Diagnostic Decision Tree

graph TD
    Start[Patient Presentation] --> N1{Neurological Symptoms}
    Start --> V1{Vascular Findings}
    Start --> S1{Systemic Markers}

    N1 -->|Progressive| N2[Bilateral LRPN]
    N1 -->|Severe| N3[Ankle Denervation]
    N1 -->|Atypical| N4[Pain Pattern]

    V1 -->|Conflicting| V2[CTA vs Doppler]
    V1 -->|Possible| V3[Embolic Events]

    S1 -->|Present| S2[Matched OGBs]
    S1 -->|Elevated| S3[CSF Protein]
    S1 -->|Normal| S4[PET Scan]

    N2 & N3 & N4 --> D1[Consider Autoimmune]
    V2 & V3 --> D2[Evaluate Vascular]
    S2 & S3 --> D3[Investigate Systemic]

    D1 & D2 & D3 --> Final[Multifactorial Process]

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Laboratory Value Trends

graph LR
    subgraph "CSF Findings"
        LP1[July 2024 LP] --> P1[Protein 1.29]
        LP1 --> G1[Glucose 5.4]
        LP1 --> O1[Matched OGBs]
        
        LP2[Dec 2024 LP] --> P2[Protein 1247]
        LP2 --> G2[Glucose 6.8]
        LP2 --> L2[Lactate 2.4]
    end

    subgraph "Key Changes"
        C1[Protein ⬆️ 966x]
        C2[Glucose ⬆️ 1.26x]
        C3[New Lactate Measurement]
    end

    P1 --> C1
    P2 --> C1
    G1 --> C2
    G2 --> C2
    L2 --> C3

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Required Investigation Pathways

graph TB
    subgraph "Autoimmune Pathway"
        A1[ANA Panel]
        A2[ANCA Panel]
        A3[Serial NCS]
    end

    subgraph "Vascular Pathway"
        V1[Thrombophilia Screen]
        V2[Coagulation Studies]
        V3[Vascular Imaging]
    end

    subgraph "Oncological Pathway"
        O1[Paraneoplastic Screen]
        O2[Colonoscopy]
        O3[PET Follow-up]
    end

    A1 & A2 & A3 -->|Results| AD[Autoimmune Decision]
    V1 & V2 & V3 -->|Results| VD[Vascular Decision]
    O1 & O2 & O3 -->|Results| OD[Oncology Decision]

    AD & VD & OD --> FD[Final Diagnosis]

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