Bruce H. Knox
Independent Scholar, Auckland, New Zealand
Publications
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Research Article
Rethinking Dysautonomia: Misdiagnosis, Neurodegenerative Bias, Multi-Factorial Pathophysiology, and the Primacy of the Patient Narrative
Author(s): Bruce H. Knox*
Dysautonomia remains one of the most diagnostically complex conditions in contemporary medicine, characterised by multi- system involvement and heterogeneous aetiology. Despite substantial evidence that autonomic dysfunction may arise from reversible, non-degenerative, and multi-factorial causes, clinical interpretation frequently defaults to neurodegenerative frameworks. This paper examines four interrelated domains contributing to this diagnostic pattern: misdiagnosis through premature closure, neurodegenerative bias in clinical reasoning, under-recognition of multi-factorial secondary dysautonomia, and the central role of the patient narrative in establishing causation. Drawing on established literature and a longitudinal clinical trajectory demonstrating severe autonomic dysfunction followed by stabilisation and recovery, this paper argues for a paradigm shift from deterministic, .. Read More»