Symptoms Without Clear Pathology: Dr Bruno Silva, Consultant Neuropsychiatrist
By Dr Bruno Silva, Consultant Neuropsychiatrist
Posted 02 February 2026
4 Minute Read
Functional and unexplained symptoms are frequently disputed in PI and CN claims, particularly around diagnosis, causation and credibility.
Claims involving neurological, cognitive or fatigue-related symptoms without clear structural pathology are often contested around diagnosis, causation, symptom validity and prognosis. In this webinar, Dr Bruno Silva shares practical neuropsychiatric insight into how functional presentations are identified, explained and relied upon in personal injury and clinical negligence litigation. Drawing on real-world (anonymised) cases, he explores how expert evidence can bring clarity where investigations are inconclusive.
About the Speaker
Dr Bruno Silva
Consultant Neuropsychiatrist & Expert Witness
Dr Bruno Silva is a Consultant Neuropsychiatrist with extensive experience assessing complex neurological and cognitive presentations within both the NHS and medico-legal settings. He is regularly instructed in personal injury and clinical negligence claims, particularly where symptoms appear disproportionate to objective findings or where investigations fail to identify clear structural pathology.
Dr Silva has a specialist interest in functional neurological disorder (FND), functional cognitive disorder, non-epileptic seizures, fatigue syndromes and post-injury neuropsychiatric presentations. His clinical approach focuses on careful history-taking, positive diagnostic features and clear differentiation between functional symptoms, malingering and structural disease.
Key Themes
In this session, Dr Silva explores:
- Functional vs structural neurological symptoms in disputed claims
- How neuropsychiatric assessment supports causation and prognosis
- Symptom validity testing, inconsistency and evidential pitfalls
- Treatment mismatch and its impact on prognosis
Medico-Legal Insights
- Functional neurological symptoms are real, involuntary and disabling, even when scans are normal.
- Inconsistency is often a diagnostic feature, not evidence of exaggeration or dishonesty.
- Neuropsychiatric evidence can clarify causation and prognosis using a vulnerability-trigger-maintaining framework.
- Failed symptom validity tests do not equate to malingering and must be interpreted in context.
- Correct diagnosis is essential - mismatched rehabilitation can prolong symptoms and weaken outcomes.
Tags:
- Neuropsychiatric
- Psychiatry Expert Witness
- Symptoms
- Pathology
Expert Disciplines:
- Neuropsychiatry
About The Author
Dr Bruno Silva
Consultant Neuropsychiatrist
Dr Bruno Silva is a Consultant Neuropsychiatrist and Medico-Legal Expert Witness providing independent opinion in personal injury, clinical negligence, and criminal/forensic claims. He is regularly instructed on matters involving breach of duty, causation, condition, and prognosis, with a balanced claimant and defendant instruction profile. His medico-legal work frequently addresses complex and disputed neuropsychiatric presentations, including cases involving functional symptoms, diagnostic uncertainty, and symptom validity where clear structural pathology is absent.
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