Lec 85

Question 1

What factors suggest non-neuro cause for disease?

Answer 1

• history of anxiety, depression, panic attacks
• multiple somatic complaints
• history of stress related disorders or other poorly defined medical syndromes [like irritable bowel, chronic fatigue, chronic lyme]
• inconsistencies on physical exam

Question 2

What are some pseudo-neurologic motor symptoms that may be seen in conversion disorder?

Answer 2

• abnormal movements
• movements worse when calling attention or light touch
• wildly ataxic
• paralysis/paresis of one or more limbs without confirming to neural paths/distribution
• normal reflexes
• co-contraction of muscles
• normal strength

Question 3

What does the arm drop test tell you?

Answer 3

• determine if non-organic weakness

if somatic/functional =

• hold pts affected arm above face and arm is dropped
• if non-organic/functional –> paralyzed arm will have “jerky descent” and not strike the patient’s face “near miss”

Question 4

What is dragging monoparetic gait?

Answer 4

leg is dragged like sack of potatoes

no external rotation or circumduction, normal reflexes no babinski

Question 5

What is hoover’s sign?

Answer 5

based on principle that flexion at one hip is accompanied by involuntary extension of contralateral joint

– examiner holds hand under “weak” limb and asks patient to flex contralateral hip against resistance

if non-organic weakness –> involuntary extension of paralyzed leg occurs when flexing contralateral leg against resistance
= positive Hoover sign

if no pressure felt = more likely organic limb weakness

Question 6

What are common sensory symptoms of non-organic disease

Answer 6

anesthesia and paresthesia especially extremities

suspicious if do not follow distribution of neuro deficit, sensation split exactly at midline

Question 7

What happens in gait disorders of non-organic disease?

Answer 7

gait disorders rapid onset, significant variability, improvement with distraction and worse with attention

has “gait problems” but does not injure him/herself

Question 8

What is astasia-abasia?

Answer 8

unusual and dramatic gait disturbance where patient lurches wildly in various directions and nearly falls only when someone or something nearby to catch them

Question 9

What is psychogenic tremor?

Answer 9

disappears with distraction and worse with observation

variable freq more likely psychogenic than variable amplitude

Question 10

What blindness in functional disease?

Answer 10

psychogenic complete blindness = unable to bring their fingers together and unable to sign their name [thought individuals who are truly blind can do both]

• normal pupil reaction

Question 11

What is psychogenic non-epileptic seizures [PNES]?

Answer 11

women > men
20-30 yo most common groups
seen in cases of physical/sexual abuse
side to side head or body turning "jactation"
seizures tend to slow down at end

eyes closed clenched mouth