Hysterical paraplegia.

Abstract

SUMMARY Between 1944 and 1984 20 patients were admitted to a spinal injuries centre with a diagnosis of traumatic paraplegia. They subsequently walked out and the diagnosis was revised to hysterical paraplegia. A further 23 patients with incomplete traumatic injuries, who also walked from the centre, have been compared with them as controls. The features that enabled a diagnosis of hysterical paraplegia to be arrived at were: (1) They were predominantly paraplegic, (2) There was a high incidence of previous psychiatric illness and employment in the Health Service or allied professions, (3) Many were actively seeking compensation. The physical findings were a disproportionate motor paralysis, non anatomical sensory loss, the presence of downgoing plantar responses, normal tone and reflexes. They made a rapid total recovery. In contrast, the control traumatic cases showed an incomplete recovery and a persistent residual neurological deficit. Investigations apart from plain radiographs of the spinal column were not warranted, and the diagnosis should be possible on clinical grounds alone.

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

“…While somatoform disorders have been described in numerous case reports of ''hysterical paralysis'' (7,8,10,11,13,25), their incidence is relatively rare (4).…”

“…The bulbocavernosus reflex is considered to be involuntary. Recovery of function in the setting of psychogenic paralysis is rapid and complete, with more than 90% of patients showing complete recovery within 1 month (7,11).…”

“…Associated symptoms can include loss of vision and hearing, pseudo-seizures, ataxia, and genitourinary and gastrointestinal dysfunction (7). The severity of motor symptoms generally exceeds that of sensory loss; rectal tone and reflexes are usually retained (8,11). 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.…”

Conversion motor paralysis disorder: analysis of 34 consecutive referrals

“…Repeated neurololgical examinations are inconsistent, especially the sensory part. 7,9 . Other clinical elements suspicious of conversion origin include normal respiration (in the presence of acute tetraplegia or hemiplegia), normal muscle tone and deep tendon re¯exes, full control of sphincters,`la belle indi erence'.…”

“…2 ± 5 Even without an organic basis for their signs and symptoms these patients often require comprehensive assessment, treatment and rehabilitation. 6,7 Initially, in many cases neither the patient nor the treating sta are aware of the conversion etiology. Patients suspected of malingering or having secondary gain from their disability must be di erentiated from those with CD.…”