Importance of clinical tests to detect non-organic paresis

Sonoo, Masahiro

doi:10.1136/jnnp-2012-304693

Cited by 6 publications

(14 citation statements)

References 4 publications

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“…104 Several bedside signs that aim to tease out the difference and demonstrate the inconsistency between voluntary and involuntary movements have been described such as give-way weakness or the sudden loss of tone or strength during isometric muscle strength testing, inverse or global pyramidal weakness, Hoover's sign, hip abductor sign, and downward drift without pronation. [104][105][106][107][108][109] These findings should support the diagnosis, and in this particular case, it is safe to remark that "inconsistency" rather than consistency is the key. Stone et al 110 found that it is productive to analyse not only the risk factors which predispose patients to develop FW, but also immediate factors at onset, such as a panic attack or physical injury as these antecedent events can serve as potential clues to the mechanism of the development of FW.…”

Section: Paucity Of Movementssupporting

confidence: 52%

“…Several bedside signs that aim to tease out the difference and demonstrate the inconsistency between voluntary and involuntary movements have been described such as give-way weakness or the sudden loss of tone or strength during isometric muscle strength testing, inverse or global pyramidal weakness, Hoover’s sign, hip abductor sign, and downward drift without pronation 104–109. These findings should support the diagnosis, and in this particular case, it is safe to remark that “inconsistency” rather than consistency is the key.…”

Section: Spectrum Of Fndsmentioning

confidence: 81%

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Functional Neurological Disorders

Mishra

Pandey

2022

The Neurologist

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Background: Functional neurological disorders (FNDs) are common but often misdiagnosed. Review Summary: The incidence of FNDs is between 4 and 12 per 100,000, comparable to multiple sclerosis and amyotrophic lateral sclerosis, and it is the second most common diagnosis in neurology clinics. Some clues in the history are sudden onset, intermittent time course, variability of manifestation over time, childhood trauma, and history of other somatic symptoms. Anxiety and depression are common, but not necessarily more than in the general population. Although there are no tests currently capable of demonstrating whether symptoms are willfully produced, there may not be a clear categorical difference between voluntary and involuntary symptoms. The prognosis of an FND is linked to early diagnosis and symptom duration, but unfortunately, the majority of the patients are diagnosed after considerable delays. Conclusions: A positive diagnosis of FNDs can be made on the basis of history and neurological signs without reliance on psychological stressors. Past sensitizing events and neurobiological abnormalities contribute to the pathogenesis of FNDs. Physical rehabilitation and psychological interventions alone or in combination are helpful in the treatment.

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Section: Paucity Of Movementssupporting

confidence: 52%

Section: Spectrum Of Fndsmentioning

confidence: 81%

Functional Neurological Disorders

Mishra

Pandey

2022

The Neurologist

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“…When the patient abducts just the "paretic" leg, both legs become weak. 16 ❚ Other symptom evaluations. For patients who have functional seizures, video electroencephalography is helpful to distinguish functional seizures from "true" seizures.…”

Section: Negative Results and Positive Signs Point To The DXmentioning

confidence: 99%

Conversion disorder: An integrated care approach

Alston¹

2023

The Journal of Family Practice

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Knowing how the diagnosis is made and the condition is managed effectively can help FPs fulfill their role in the multifaceted care of these patients. THE CASEJanice M* presented to the emergency department (ED) with worsening slurred speech. The 55-year-old patient's history was significant for diabetes; hypertension; depression; sleep apnea; multiple transient ischemic attacks (TIAs) thought to be stress related; and left lower-extremity weakness secondary to prior infarct. Ms. M had been to the hospital multiple times in the previous 2 to 3 years for similar symptoms. Her most recent visit to the ED had been 2 months earlier.In the ED, the patient's NIH stroke score was 1 for the presence of dysarthria, and a code for emergency stroke management was initiated. Ms. M was alert and oriented x 3, with no focal motor or sensory deficits noted. Computed tomography (CT) and CT angiography were negative for any acute abnormality. Throughout the course of the ED visit, her NIH score improved to 0. Ms. M exhibited staccato/stuttering speech, but it was believed that this would likely improve over the next few days.According to the hospital neurologist, the ED work-up suggested either a TIA, stressinduced psychiatric speech disorder, or conversion disorder. The patient was discharged home in stable condition and was asked to follow up with the outpatient neurologist in 1 week.Ms. M was seen approximately 2 weeks later in the outpatient neurology stroke clinic. Her symptoms had resolved, and she did not report any new or worsening symptoms. An outpatient stroke work-up was initiated, including magnetic resonance imaging (MRI) of the brain, echocardiography, and measurement of low-density lipoprotein and hemoglobin A1C; all results were unremarkable. Given the timeline for symptom improvement and results of the work-up, the patient was given a diagnosis of conversion disorder. Ms. M was encouraged to follow up with her primary care physician (PCP) for further medical management. HOW WOULD YOU PROCEED WITH THIS PATIENT?* The patient's name has been changed to protect her identity.

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“…Beyond the classic features of functional neurologic disorder, many other examination signs have been previously described, which aid in diagnosing the condition and conveying the diagnosis. When evaluating functional weakness, Hoover’s, reverse Hoover’s, abductor sign, barre sign, or positive “make a fist” test can be seen [12] , [13] , [14] , [15] . In cases of hyperkinetic disorders, “stretched slinky”, “whack-a-mole,” and coactivation sign can be observed [4] , [16] , [17] .…”

Section: Discussionmentioning

confidence: 99%

The selfie sign in the diagnosis of functional tremor

Assaedi,

Yu,

Siddiqui

et al. 2024

Clinical Parkinsonism & Related Disorders

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Importance of clinical tests to detect non-organic paresis

Cited by 6 publications

References 4 publications

Functional Neurological Disorders

Functional Neurological Disorders

Conversion disorder: An integrated care approach

The selfie sign in the diagnosis of functional tremor

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