A New Clinical Evaluation for Hysterical Paralysis

Abstract

The Spinal Injuries Center test is a new clinical evaluation method that can help make a correct diagnosis of hysterical paralysis. When a patient is unable to lift up his knees by himself, the result of the Spinal Injuries Center test is considered to be positive, and hysterical paralysis is diagnosed in such patients. The diagnosis of hysterical paralysis must be ruled out when encountering patients with paralysis, and as a result, imaging and electrophysiological studies are often necessary. Unfortunately, such tests are costly. Thus, a new clinical evaluation for the diagnosis of hysterical paralysis, named the Spinal Injuries Center test, was developed. When patients who are unable to lift up their knees by themselves test positive using the Spinal Injuries Center test, then they are considered to have ether hysterical or simulated paralysis.

Evaluation of Neurologic Deficit Without Apparent Cause: The Importance of a Multidisciplinary Approach

“…While the examiner supports both limbs from the heels, the patient is asked to lift the affected extremity; the absence of downward heel pressure in the contralateral (uninvolved) limb is indicative of apathy of intent. As with Barré's test, Hoover's test is of no use in the evaluation of paraplegia (12).…”

“…The presence of normal SSEPs and MEPs shows a functioning cerebral-spinal axis and would suggest an inorganic component to the paralysis. While very sensitive and effective for identifying psychogenic paralysis, neurophysiologic testing is costly and may not be available at all institutions (12).…”

“…The Spinal Injuries Center (SIC) Test was described by Yugue et al (12) for the evaluation of conversion disorder with motor deficit involving the lower extremities. The patient is placed in the supine position and the physician passively lifts the patient's knees to a flexed position with feet flat on the bed.…”

“…In a small study, 12 of 14 patients diagnosed with hysterical paralysis exhibited either diminished rectal tone, diminished rectal sensation, or diminished deep tendon reflexes. However, all 14 retained their bulbocavernosus reflex (12). Rectal tone has a volitional component, and rectal sensation is to a degree a subjective finding based on patient reporting.…”

Funktionelle Störungen in der Neurologie

“…Darüber hinaus findet man bei einer psychogenen Lähmung meistens die folgenden Untersuchungsbefunde: normales Reflexmuster, normale Blasenfunktion und Analreflex, normale gastrointestinale Funktion [47].Allerdings kann auch eine inkomplette "echte" bzw. suprasakral gelegene Lähmung zumindest die meisten der oben genannten Funktionen unbeeinträchtigt lassen.…”