Among inpatients with facial diplegia, one-half (22 patients) had benign, self-limited causes, including Bell's palsy (10), Guillain-Barré syndrome (5), multiple idiopathic cranial neuropathies (3), brainstem encephalitis (2), Miller Fisher syndrome (1), and association with benign intracranial hypertension (1). Nine patients had tumors: four meningeal, three prepontine, and two intrapontine. Syphilis (2 patients), Hansen's disease (1), cryptococcal meningitis with acquired immunodeficiency syndrome (1), and tuberculous meningitis (1) constituted those with an infectious etiology, while miscellaneous causes included one patient each with diabetes, sarcoidosis, head trauma, pontine tegmental hemorrhage, undiagnosed Möbius syndrome in an adult, systemic lupus erythematosus with severe neuropathy, and slowly progressive degeneration--possibly bulbospinal neuronopathy. Bilaterality makes facial neuropathy a more ominous sign with widely varying causes that requires prompt investigation.

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Simulated gait abnormalities involve weakness of 1 or both legs or ataxia and trembling. The patterns rarely duplicate those of neurologic disability and are usually promptly suspected of being functional by the experienced clinician. As with other pseudoneurologic signs, normal underlying neurologic function must be demonstrated. A dramatic cure is the best diagnostic evidence, and a bias toward organic etiology is warranted by a relatively greater risk in delayed diagnosis. Dystonia and chorea are the signs most likely to be mistaken for functional conditions. While CT and MRI now provide a welcome diagnostic safety net, the variety of hysterical gaits, and probably the effectiveness of "moral" treatment, does not appear to have changed appreciably in the past century.

The pretectal syndrome occurred in 2.3% of patients personally examined over an 18-year period. The symptoms were nonspecific, but the signs (abnormal pupils in 198 patients, vertical gaze limitation in 180, disjunctive horizontal eye position in 90 and vertical in 79, lid retraction in 83, and convergence-retraction nystagmus in 71) were exquisitely localizing. The etiology, skewed by the local prevalence of cysticercosis, was hydrocephalus in 80 patients, stroke in 53, and tumor in 45. The importance of timely diagnosis was underscored by the relatively good prognosis of many patients.