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GLOSSARY
A
Absence Seizures
A type of seizure involving staring spells. This type of seizure is a brief (usually less than 15 seconds) disturbance of brain function due to abnormal electrical activity in the brain.
Acetylcholine Receptor Antibody (AChR)
A Protein found in the blood which affects a chemical that sends signals from nerves to muscles and between nerves in the brain.
Acquired Brain Injury
Any type of brain damage that occurs after birth. It can include damage sustained by infection, disease, lack of oxygen or a blow to the head.
Anhedonia
The reduced ability to experience pleasure, often seen in neuropsychiatric disorders.
Antibodies
A protein produced by the body's immune system when it detects harmful substances, called antigens.
Anticonvulsant
A medication used to control (prevent) seizures (convulsions) or stop an ongoing series of seizures.
Anti-GAD Antibodies
Antibodies that target an enzyme called Glutamic Acid Decaroxylase. This enzyme is responsible for converting f
glutamic acid to GABA, a chemical found in high concentrations in the cerebellum. It is believed that the lack of GABA results in cerebellar ataxia.
Antigen
A substance that stimulates the production of an antibody when introduced into the body. Antigens include toxins, bacteria, viruses, and other foreign substances.
Anti-NMDA Receptor Encephalitis
A disease occurring when antibodies produced by the body's own immune system attack NMDA receptors in the brain. NMDA receptors are proteins that control electrical impulses in the brain. Their functions are critical for judgement, perception of reality, human interaction, the formation and retrieval of memory, and the control of unconscious activities (such as breathing, swallowing, etc.), also known as autonomic functions.
Antinuclear Antibody (ANA)
Substances produced by the immune system that attack the body's own tissues.
Antiphospholipid Syndrome
A disorder characterized by elevated levels of multiple different antibodies that are associated with clots in both the arteries and veins.
Antithyroid Antibodies
Antibodies directed against the thyroid gland. Antithyroid antibodies can be associated with inflammation of the thyroid gland and affect its function. Antithyroglobulin and antimicrosomal antibodies are examples of antithyroid antibodies.
Antithyroid Peroxidase Antibody Test
The most sensitive test for detecting autoimmune thyroid disease.
Aphasia
A neurological disorder caused by damage to the portions of the brain that are responsible for language production or processing. It may occur suddenly or progressively, depending on the type and location of brain tissue involved. Primary signs of the disorder include difficulty in expressing oneself when speaking, trouble understanding speech, and difficultry with reading and writing. Aphasia is not a disease, but a symptom of brain damage. Although it is primarily seen in individuals who have suffered a stroke, aphasia can also result from a brain tumor, infection, inflammation, head injury, or dementia that affect language-associated regions of the brain.
Arachnoid Cyst
A cerebrospinal fluid-filled sac that is locatd between the brain or spinal cord and the arachnoid membrane, one of the three membranes that cover the brain and spinal cord.
Arrhythmia
A problem with the rate or rhythm of the heartbeat. It means that the heart beats too quickly, too slowly, or with an irregular pattern.
Ataxia
A lack of muscle control during voluntary movements, such as walking or picking up objects. A sign of an underlying condition, ataxia can affect movement, speech, eye movement and swallowing.
Autoantibodies
Antibodies, or immune proteins that mistakenly target and react with a person's own tissues or organs.
Autoimmune Disease
Disease which develops when the immune system, which defends the body against disease, decides healthy cells are foreign, and begins attacking healthy cells. Depending on the type, an autoimmune disease can affect one or many different types of body tissue. It can also cause abnormal organ growth and changes in organ fuction.
Autonomic Nervous System
A part of the nervous system that regulates key involuntary functions of the body, including the activity of the heart muscle; the smooth muscles, including the muscles of the intestinal tract; and the glands. The autonomic nervous system has two divisions: the sympathetic nervous system and the parasympathetic nervous system.
Avascular Necrosis
Death of bone tissue due to a lack of blood supply. Also called osteonecrosis, it can lead to tiny breaks in the bone and the bone's eventual collapse. The blood flow to a section of bone can be interrupted if the bone is fractured or the joint becomes dislocated. It is also associated with long-term use of high-dose steroid medications and excessive alcohol intake.
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B
Biomarker
A distinct biochemical, genetic or molecular characteristic or substance that is an indicator of a particular biological condition or process.
Blood Brain Barrier
A network of vessels that form a structural and chemical barrier between the brain and systemic circulation.
Brain Fog
A condition that affects all ages and which is characterized by confusion, decreased clarity of thought, and forgetfulness.
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C
Cerebellum
A large portion of the brain, serving to coordinate voluntary movements, posture, and balance in humans. It is located in back of and below the cerebrum and consisting of two lateral lobes and a central lobe.
Cerebral Infarction
Also known as an ischemic stroke, this occurs when the blood vessels that supply the brain are disturbed so that blood flow is interrupted. There are two common types of ischemic stroke: atherothrombotic, embolic, as well as other less common causes. The cause of an ischemic stroke cannot be determined in approximately 40% of cases.
Cerebritis
Inflammation of the brain casued by infection or inflammation from disease.
Cerebrospinal Fluid (CSF)
A clear, colorless liquid that surrounds and protects the CNS. It bathes the brain and spine in nutrients and eliminates waste products. It also cushions them to help prevent injury in the event of trauma.
Cerebrovascular
Of, relating to, or affecting the cerebrum and its associated blood vessels.
Chronic Fatigue Syndrome
A debilitating and complex disorder characterized by profound fatigue that is not improved by bed rest and that may be worsened by physical or mental activity.
Complex Partial Seizure
A type of seizure that usually starts in a small area of the temporal lobe or frontal lobe of the brain, and quickly involve other areas of the brain that affect alertness and awareness.
Computed Tomography (CT)
An imaging procedure that uses special x-ray equiptment to create detailed pictures or scans of areas inside the body.
Conversion Disorder
A disorder characterized by the presence of symptoms, such as paralysis, tremor, visual or auditory problems, that resemble those of nervous system dysfunction but cannot be explained by a neurological disorder. Developement of the disorder is often associated with psychological stress or trauma.
Corticosteroids
Man-made drugs that closely resemble cortisol, a hormone that the adrenal glands produce naturally. Corticosteroids are often referred to by the shortened term "steroids." (Corticosteroids are different from the male hormone-related steroid compounds that some athletes abuse.)
Cross-Reactivity
The reaction between an antigen and an antibody that was generated against a different but similar antigen; also the reaction between two different species as opposed to self-reactivity.
Cytokines
Any of a class of immunoregulatory proteins that are secreted by cells especially of the immune system.
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D
Distal
Situated away from the center of the body,or from the point of origin; specifically applied to the extremity or distant part of a limb or organ.
Dopamine
A neurotransmitter that helps control the brain's reward and pleasure center.
Dysarthria
Speech that is characteristically slurred, slow, and difficult to understand due to disease of the central nervous system causing paralysis, incoordination or spasticity of the muscles used for speaking. A person with dysarthria may also have problems controlling the pitch, loudness, rhythm, and voice qualities of his or her speech.
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E
F
Fasciculation
Involuntary contration or twitching of groups of muscle fibers.
Flooding
An experience that occurs after a brain injury because the filters that normally work to allow a person to filter through everything that comes into the brain no longer work properly. The result is an inability to rationally deal with the situation; fear prevails, and the amygdala creates a fight or flight or freeze reaction. Flooding can cause an overflow of extreme emotion, irratibility, sensory issues or other.
Focal Slowing
The most common abnormality associated with focal lesions of any type, including (but not limited to) neoplastic, vascular, subdural collections, traumatic, and infectious.
Edema
A condition of abnormally large fluid volume in the circulatory system or in tissues between the body's cells or interstitial spaces.
Electrocardiogram (ECG/EKG)
A test that checks for problems with the electrical activity of the heart. An EKG shows the heart's electrical activity as line tracings on paper.
Electrocardiograph
An instrument for recording the changes of electrical potential occuring during the heartbeat used especially in diagnosing abnormalities of heart action.
Electroencephalogram (EEG)
A test that measures and records the electrical activity of the brain. Special sensors are attached to the head and hooked by wires to a computer which then records the brain's electrical activity on the screen or on paper as wavy lines.
Electroencephalograph
An instrument for measuring and recording the electric activity of the brain.
Electromyograph
A machine used to detect and record the electrical potential generated by muscle cells when they are activated.
Electromyogram (EMG)
A test that measures the electrical activity of muscles at rest and during contraction.
Encephalitis
An acute inflammation of the brain that is caused by either a viral infection or the immune system mistakenly attacking brain tissue.
Encephalitides
Plural of encephalitis.
Encephalomyelitis
An inflammation of both the brain (encephalitis) and spinal cord (myelitis).
Encephalopathy
A general term describing a disease that affects the fuction or structure of your brain. There are many types of encephalopathy and brain disease. Some types are permanent and some are temporary. Some types are present from birth and never change, while others are acquired after birth and may get progressively worse.
Endocrinologist
A physician who has the training to diagnose and treat hormone imbalances and problems by helping to respore the normal balance of hormones in the body. The common diseases and disorders of the endocrine system that are dealt with enclude diabetes mellitus and thyroid disease. Most endocrinologists are not able to diagnose or treat Hashimoto's encephalopathy.
Epidural blood patch
A treatment for spinal headaches. In the procedure, a doctor will take a blood sample from a patient and then inject that blood back into a hole in the epidural space. The blood clots, helping to “patch” punctures after a spinal tap procedure.
Epileptiform
EEG patterns that include a wave that stands out from the background in frequency, amplitude and/or field.
Euthyroid
The state of having a normal thyroid gland function.
Executive Function
The mental process that enables a person to plan, focus attention, remember instructions, and handle multiple tasks successfully.
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G
GABA
Gamma-aminobutyric acid, or GABA, is a neurotransmitter that sends chemical messages through the brain and the nervous system, and is involved in regulating communication between brain cells.
Generalized Slowing
One of the most common EEG findings in diffuse encephalopathies.
Glucocorticoids
Steroid hormones that are produced by the adrenal gland and known particularly for their anti-inflammatory and immunosuppressive actions.
Glucose
A simple sugar found in the blood, glucose is the chief source of energy, and is the main sugar that the body manufactures.
Glycine
Once of the non-essential amino acids used to help create muscle tissue and convert glucose into energy. It is also essential to maintaining healthy central nervous and digestive systems, and has recently been shown to provide protection via antioxidants from some types of cancer.
Glymphatic System
The system or process by which cerebrospinal fluid moves through channels formed by glia, cleansing the mammalian brain of harmful waste.
Grand Mal Epilepsy
See Tonic-Clonic Seizure
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H
Holistic
The consideration of the complete person, physically, psychologically, socially, and spiritually, in the management and prevention of disease. Holistic medicine treats the symptoms in addition to looking for the underlying causes. It is important to note if you are under the care of a non holistic physician, it is important to mention you will be considering holistic medicine as some interact with immune suppresive treatments.
Hypnagogic
Of, relating to, or occurring in the stste of intermediate consciousness preceding sleep.
Hypoperfusion
A decrease in blood flow through an organ, as in circulatory shock; if prolonged, it may result in permanent cellular dysfunction and death.
Hypoxia
A deficiency of oxygen reaching the tissues of the body.
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I
Idiopathic
Arising from and unknown cause.
Immunoglobulin G (IgG)
The smallest but most common antibody of all the antibodies in the body; found in all body fluids, it is important in fighting bacterial and viral infections.
Immunomodulator
Natural or synthetic substances that help regulate or normalize the immune system.
Immunosuppressant
A class of drugs that suppress or reduce the strength of the body's immune system.
Intrathecal
Within a sheath, specifically, the spinal canal, in the subarachnoid or subdural space.
Intravenous Immunoglobulin (IVIG)
A solution containing concentrated human immunoglobulins (antibodies), primarily IgG. IVIG has numerous uses in healthcare, including as replacement therapy for patients with primary immune deficiencies.
Ischemia
A decrease in the blood supply to a bodily organ, tissue, or part caused by constriction or obstruction of the blood vessels.
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L
Leptomeningeal Disease
A rare complication of cancer in which the disease spreads to the membranes (meninges) surrounding the brain and spinal cord.
Low Dose Naltrexone (LDN)
The use of naltrexone in doses approximately one-tenth those used for drug/alcohol rehabilitaion purposes, as an "off-label" treatment for certain immunologically-related disorders.
Lumbar Puncture
A diagnostic procedure in which a long needle is inserted into the subarachnoid space between the 3rd and 4th lumbar vertebrae in order to obtain cerebrospinal fluid (CSF) for diagnostic or theraputic purposes.
Lymphatic System
A network of tissues and organs that help rid the body of toxins, waste and other unwanted materials.
Lymphocyte
Any of the nearly colorless cells formed in lymphoid tissue, as in the lymph nodes, spleen, thymus, and tonsils. Lymphocytes constitute between 22 and 28 percent of all white blood cells in the blood of a normal human adult.
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M
Magnetic Resonance Angiography (MRA)
A noninvasive imaging of blood vessels by magnetic resonance imaging. The technique does not expose patients to ionizing radiation and avoids catheterization of the vessels. It has been used to study aneurysms, blockages, and other diseases of the carotid, coronary, femoral, iliac and renal arteries. Studies may be done with or without contrast agents.
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Magnetic Resonance Imaging (MRI)
A noninvasive medical diagnostic technique in which the absorption and transmission of high-frequency radio waves are analyzed as they irradiate the hydrogen atoms in water molecules and other tissue components placed in a strong magnetic field. This computerized analysis provides an aid to the diagnosis and treament planning of many diseases.
Manometer
An instrument used for measuring the pressure of liquids and gases.
Microsomal Antibody
Antithyroid microsomal antibody is a test to measure antithyroid microsomal antibodies in the blood. Microsomes are found inside thyroid cells. The body produces antibodies to microsomes when there has been damage to thyroid cells.
Myelin
A fatty substance that wraps around nerve fibers and serves to increase the speed of electrical communication between neurons.
Myelopathy
Any functional disturbance and/or pathological change in the spinal cord.
Myoclonus
A term for sudden, rapid, brief, involuntary jerking of a muscle or group of muscles.
Myofascial
The fibrous tissue that encloses and separates layers of muscles.
Myoneural
Relating to both muscles and nerves, especially to nere endings in muscle tissue.
Myositis
A rare disease in which the immune system chronically inflames the body's own healthy muscle tissue. Persistent inflammation progressively weakens the muscles.
Myxedema
A disease caused by decreased activity of the thyroid gland in adults and characterized by dry skin, swellings around the lips and nose, mental deterioration, and a subnormal basal metabolic rate.
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Narcolepsy
A chronic sleep disorder characterized by oerwhelming daytime drowsiness and sudden attacks of sleep. People with narcolepsy often find it difficult to stay awake for long periods of time, regardless of the circumstances. Narcolepsy can cause serious disruptions in the patient's daily routine.
Naturopathy
A distinct primary health care profession, emphasizing prevention, treatment, and optimal health through the use of natural or holistic therapeutic methods and substances that encourage individuals' inherent self-healing process.
Neurobehavioral
Of or relating to the relationship of the nervous system, especially the brain, to behavior and learning.
Neurodegenerative
The progressive degeneration of the structure and function of the central nervous system or peripheral nervous system.
Neuroendocrine
The study of the anatomical and physiological interactions between the nervous and endocrine systems.
Neuroimmunology
A branch of immunology concerned with the interactions between immunological and nervous system functions, especially as they apply to various autoimmune diseases.
Neurologist
A specialist in the diagnosis and treatment of disorders of the neuromuscular system: the central, peripheral, and autoinomic nervous systems, the neuromuscular junction and muscles.
Neuromyotonia
A very rare condition of spontaneous, continuous muscle activity of peripheral nerve origin. It is characterized clinically by muscle twitching at rest or cramps that can be triggered by voluntary or induced muscle contraction, and impaired muscle relaxation. Often, patients also have symptoms of excessive sweating and more rarely mild muscular weakness, and paraesthesia. Also known as Isaacs Syndrome.
Neuropathy
A condition affecting the nerves supplying the arms and legs. Typically, the feet and hands are involved first. If sensory nerves are involved, numbness, tingling, and pain are prominent, and if motor nerves are involved, patient weakness is present.
Neuroplasticity
The ability of the nervous system to adapt to trauma or disease; the ability of nerve cells to grow and form new connections to other neurons.
Neuropsychiatry
A medical subspecialty committed to better understanding links between neuroscience and behavior, and to the care of individuals with neurologically based behavioral disturbances.
Neuropsychological Rehabilitation
A framework of interventions designed to improve cognitive, emotional, and psychosocial functioning due to changes in the brain.
Neutrophils
A type of immune cell that is one of the first cell types to travel to the site of an infection. Neutrophils help fight infection by ingesting microorganisms and releasing enzymes that kill the microorganisms. A neutrophil is a type of white blood cell, a type of granulocyte, and a type of phagocyte.
Nystagmus
Involuntary movements of the eyeballs; its presence or absence is used to diagnose a variety of neurological and visual disorders.
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Olfactory
Of, relating to, or connected with the sense of smell.
Oligoclonal Bands
Proteins called immunoglobulins, the presence of which, when found in the cerebrospinal fluid, is indicative of inflammation of the CNS.
Orthostatic Hypotension
Also called postural hypotension, it is a form of low blood pressure that happens when a patient stands up from sitting or lying down; can make the patient feel dizzy or lightheaded, and maybe even faint, but is often mild, lasting only a few seconds to a few munutes after standing.
Osteopathy
A form of drug-free non-invasive manual medicine that focuses on total body health by treating and strengthening the musculoskeletal framework, which includes the joints, muscles and spine. Its aim is to positively affect the body's nervous, circulatory and lymphatic systems.
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Paraneoplastic Syndrome
A group of rare disorders that are triggered by an abnormal immune system response to a cancerous tumor known as a neoplasm. Paraneoplastic syndromes are thought to happen when cancer-fighting antibodies or white blood cells mistakenly attack normal cells in the nervous system.
Pathogenesis
The pathologic, physiologic, or biochemical mechanism resulting in the development of a disease.
Peripheral
Situated away from the center, as opposed to centrally located.
Peripheral Neuropathy
A wide range of disorders in which the nerves outside of the brain and spinal cord have benn damaged.
Periventricular
Pertaining to the area surrounding or near the ventricles, especially the ventricles of the brain.
Petit Mal Epilepsy
See Absence Seizure
Phenotype
The observable physical or biochemical characteristics of an organism, as determined by both genetic makeup and enviornmental influences.
Photomyogenic
Denoting an electroencephalographic response tophotic stimulation (brief flashes of light) marked by myoclonus of the facial muscles.
Photoparoxysmal
An abnormal electroencephalographic response to photic stimulation (brief flashes of light), marked by diffuse paroxysmal discharge recorded as spikewave complexes; the response may be accompanied by monor seizures.
Pituitary Microadenoma
A benign (non-cancerous) growth in the pituitary gland that is smaller than 10 millimeters in size.
Plasma Exchange
See Plasmapheresis
Plasmapheresis (PLEX)
A procedure in which whole blood is taken from a person and separated into plasma and blood cells; the plasma is removed and replaced with another solution, such as saline solution, albunn or specially prepared donor plasma; and the reconstituted solution is then returned to the patient. Plasmapheresis is used in the treatment of many different conditions including autoimmune disorders. When the plasma is removed, it takes with it the antobodies that have been developed against self-tissue in an attmpt to reduce the attack on the patient's own body.
Port
A thin flexible tube placed in a large vein, connected to a circular chamber implanted under the skin, used for taking blood samples and for giving fluids or drug treatment without having to find a vein.
Positron Emission Tomography (PET)
A computerized diagnostic technique that uses small amounts of radioactive materials called radiotracers, a special camera and a computer to help evaluate organ and tissue functions.
Prophylaxis
A measure taken to prevent or protecto against disease, often involving the use of a biologic, chemical, or mechanical agent to destroy or prevent the entry of infectious organisms.
Proximal
Nearer to a point of reference or attachment, usually the trunk of the body, than that location is to other parts of the body.
Psychoneuroimmunology
Involves several disciplines that studies the complex interactions between the nervous and immune systems, where the neuroendocrine system controls immune function, nervous and immune interactions influence psychosocial dynamics.
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Quantitative EEG
The measurement, using digital technology, of electrical patterns at the surface of the scalp which primarily reflect cortical electrical activity or "brainwaves."
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Relapsing-Remitting
A pattern of symptoms in which symptomatic attacks occur that last 24 hours or more, followed by complete or almost complete improvement.
Romberg Test
A test used for the clinical assessment of patients with disequilibrium or ataxia from sensory and motor disorders.
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Serotonin Syndrome
A potentially fatal condition caused by excessive levels of serotonin in the brain, most often caused by drug interactions or overdose.
Simple Partial Seizure
A type of seizure localized to one area on one side of the brain, but which may spread from there. Simple partial seizures are usually divided into one of four categories; motor, sensory, autonomic, or psychic, depending on the type of symptoms the person experiences. Consciousness is not lost during a simple partial seizure.
Single Photon Emisison Computed Tomography (SPECT)
A type of imaging test which uses a radioactive substance and a special camera to create 3-D images that provide information about blood flow to tissues and chemical reactions in the body.
Somatization
A tendency to experience and communicate psychological distress in the form of physical symptoms.
Spinal headache
Spinal headaches develop in 10-40% of individuals who receive lumbar punctures to treat certain medical conditions. A patch can effectively seal the leak at the site or relieve low pressure states in the head.
Status Epilepticus
A continuous seizure lasting more than 30 min. or two or more seizures without full recovery of consciousness between any of them. If untreated for a prolonged period it can lead to long-term disability or death.
Striational Antibodies
A type of antibody associated with older patients with myasthenia gravis and thymoma.
Subacute
The course of a disease of moderate duration or severity; one that develops more slowly than an acute illness, but more rapidly than a chronic illness.
Subcortical
Pertaining to the region beneath the cerebral cortex.
Syncope
A temporary loss of consciousness and posture, described as "fainting" or "passing out", which is usually related to temporary insufficient blood flow to the brain. This most often occurs when the blood pressure is too low and the heart doesnt pump a normal supply of oxygen to the brain.
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Tachycardia
A faster than normal heart rate at rest.
Tardive Dyskinesia
A disorder that involves involuntary movements, most commonly affecting the lower face, which may develop as a serious side effect when taking neuroleptic medications.
Temporal Lobe
One of the four main lobes or regions of the cerebral cortex, involved in organizing sensory input, auditory perception, language and speech production, as well as memory association and formation.
Teratoma
A tumor composed of different kinds of tissue, none of which normally occurs together or at the site of the tumor. Teratomas are most common in the ovaries or testes.
Thyroid Peroxidase (TPO)
An enzyme normally found in the thyroid gland, which plays an important role in the production of thyroid hormones.
Thyroid Peroxidase Antibody Test
A test which checks the levels of antibodies made against the compound thryoid peroxidase (TPO) in the bloodstream, used primarily to help diagnosis and moniter autoimmune conditions involving the thyroid gland.
Thyroid Stimulating Hormone (TSH)
A hormone produced by the pituitary gland. Its role is to regulate the production of hormones by the thyroid gland.
Thyrotoxic
An acute, life-threatening condition that is characterized with high levels fo thyroid hormones; also called thyrotoxicosis or thyroid storm.
Thyroxine (T4)
The main hormone secreted into the bloodstream by the thyroid gland. It plays vital roles in digestion, heart and muscle function, brain development and maintenance of bones. It is the inactive form and most of it is converted to an active form called triiodothyronine (T3) by organs such as the liver and kidneys.
Titer
A measurement of the amount or concentration of a substance in a solution. It usually refers to the amount of antibodies found in a patient's blood.
Transient Ischemic Attack (TIA)
A transient stroke that lasts only a few minutes. It occurs when the blood supply to part of the brain is briefly interrupted.
Traumatic Brain Injury (TBI)
A nondegenerative, noncongenital injury to the brain from an external mechanical force, possibly leading to permanent or temporary impairment of a cognitive, physical, and psychosocial functions, with an associated diminished or altered stated of consciousness.
Triiodohyronine (T3)
The actie form of the thyroid hormone, thyroxine. Approximately 20% of triiodothyronine is secreted into the bloodstream directly by the thyroid gland. The remaining 80% is produced from conversion of thyroxine by organs such as the liver and kidneys. Thyroid hormones play vital roles in regulating the body's metabolic rate, heart and digestive functions, muscle control, brain development and the maintenance of bones.
Triphasic Waves
Distinctive, but non specific, EEG pattern found in metabolic encephalopathies and a variety of other neurologic conditions.
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Vasculitis
An inflammation of the blood vessels that happens when the body's immune system attacks them by mistake. It can happen because of an infection, a medicine, or another disease, however cause is often unknown. Vasculitis can affect arteries, veins and capillaries.
Vertigo
A specific kind of dizziness in which a patient senses that they or the enviornment, are moving or spinning, even the surroundings are stable and there is no movement.
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Zebra
In medicine, refers to a very unlikely diagnostic possibility. (Ex: "When you hear hoofbeats, you think horses not zebras")
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