A Case of Functional (Psychogenic) Monocular Hemianopia Analyzed by Measurement of Hemifield Visual Evoked Potentials

Yoneda, Tsuyoshi; Fukuda, Ken; Nishimura, Mayu; Fukushima, Atsuki

doi:10.1159/000357279

Cited by 4 publications

(1 citation statement)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This finding suggests that although the structural motor pathways are preserved in motor functional neurological disorders, there is an alteration in the pathways involved in motor planning. Similar studies have been done using evoked potentials in patients with sensory, visual, hearing, and movement disorder manifestations of functional neurological disorders (19)(20)(21)(22). These studies show normal function of the primary pathways (motor efferent systems and the sensory afferent pathways) but alterations at the level of premotor and sensory association cortex processing.…”

Section: Physiological Studiessupporting

confidence: 58%

Treatment for Patients With a Functional Neurological Disorder (Conversion Disorder): An Integrated Approach

O’Neal

Baslet

2018

AJP

View full text Add to dashboard Cite

The care of patients with functional neurological disorders overlaps both the neurology and psychiatry specialties. It is often the case that neither provider thinks that he or she should be the treating clinician, and as a result, this patient group can suffer a substantial gap in care. Here, we illustrate a practical approach toward integration of care to appropriately treat patients with functional neurological disorders. DEFINITIONSThe chapter on somatic symptoms and related disorders in DSM-5 encompasses several psychiatric disorders for which the primary feature is a symptom related to a physical or health-related complaint. The diagnostic criteria for somatic symptom disorder require that the patient have one or more Which of the following reflects a DSM-5 criterion for conversion disorder (functional neurologic symptom disorder)?A. Symptoms of altered voluntary motor, cognitive, or sensory function. B. Clinical findings compatible with a recognized neurologic condition. C. Symptom onset following an identified stressor. D. Evidence of intentional production of neurologic symptoms. "Ms. A," a 29-year-old woman, was referred for a second neurologic opinion. Several months earlier, she woke with a pins-and-needles sensation involving both legs from the knees to the toes. The following day, she could not move her legs without help from her fiancé. Several hours later, she developed transient numbness of the left arm. Alarmed by her increasing symptoms, she presented to the emergency department. A brain and cervical MRI with gadolinium contrast showed no abnormalities. The patient was discharged with neurologic follow-up. Results of an electromyogram and nerve conduction study of the upper and lower extremities were normal. Later, because of increasing back and diffuse leg pain, the patient underwent a lumbar MRI, which also showed no abnormalities. She continued to experience lower extremity weakness and paresthesias as well as back and leg pain. No diagnosis was made. The patient had been unable to work since her symptoms began.Ms. A had a history of posttraumatic stress disorder related to a rape in college. She still endorsed presence of frequent nightmares and flashbacks related to the experience. She denied hypervigilance or avoidance related to her trauma. She denied any history of depression or other anxiety symptoms.On examination the patient had diffuse lower extremity weakness with variability of effort (the strength of her lower extremities did not consistently show the same response, as would be expected in a physiological motor deficit). Her reflexes were normal and there were no pathological reflexes. Sensation to pinprick was decreased in both legs without a sensory level or a dermatomal pattern (if a patient has a spinal cord abnormality, a sensory level would be an expected finding, or if there were cauda equina involvement, the sensory loss should conform to that of multiple sensory dermatomes). The patient's vibratory sense was diminished over the thoracic but not the lumbar vertebrae or in...

show abstract

Section: Physiological Studiessupporting

confidence: 58%