Functional Neurological Symptoms Flashcards Preview

Systems: Neurology AB > Functional Neurological Symptoms > Flashcards

Flashcards in Functional Neurological Symptoms Deck (15)
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1
Q

Functional symptoms in medicine: gastroenterology

A

IBS

2
Q

Functional symptoms in medicine: endocrinology

A

Borderline TFTs

3
Q

Functional symptoms in medicine: respiratory

A
  • Chronic cough

- Brittle ‘asthma’

4
Q

Functional symptoms in medicine: rheumatology

A
  • Fibromyalgia

- Some chronic back pain

5
Q

Functional symptoms in medicine: gynaecology

A
  • Chronic pelvic pain

- Some dysmenorrhoea

6
Q

Functional symptoms in medicine: cardiolgy

A
  • Atypical/non-cardiac chest pain

- Some palpitations

7
Q

Functional symptoms in medicine: infectious diseases

A

Post viral chronic fatigue (CFS/ME)

8
Q

Functional symptoms in medicine: ENT

A
  • Globus

- Functional dysphonia

9
Q

Definition of functional symptoms

A

Change in function rather than structure of a system (blackouts, paralysis, abnormal movements). Symptoms not explained by a neurological disease.

10
Q

What is important when taking a history?

A

-List all symptoms
-Ask about disability(“ What is a typical day like?”)
-Onset and Course
Timeline (“When last did you feel well?”
“What happened with previous doctors?”)
-Dissociative symptoms
-Illness beliefs
-Social (Work, money, the law, relationships History of abuse- second consultation)
-GET THE OLD NOTES

11
Q

What may be found on examination?

A
  • Inconsistency
  • Positive functional signs
  • Absence of signs of disease
  • Eye movements: convergence spasm
  • Tremor: disappears with distraction, entrainment
  • Paralysis: Leg dragged, hip internally/ externally rotated,“Give way weakness”, Inverted pyramidal weakness (Extensors vs Flexors)
  • “Fixed” dystonia, complex regional pain after minor injury
12
Q

What tests can assess functional weakness?

A
  • Hoover’s sign

- Abductor’s sign

13
Q

What investigations can be carried out?

A
  • MRI brain
  • Negative video EEG
  • Functional MRI
14
Q

How should functional symptoms be managed?

A
  • Explain, reassure
  • Use of metaphors to explain
  • Discuss role of depression/anxiety (antidepressants)
  • Referral
  • Support organisations and information
15
Q

What are the outcomes of functional symptoms in neurology?

A
  • Prognosis (attendance at A+E usually drops)
  • Misdiagnosis (5%)
  • Litigation
  • Disability and incapacity benefits
  • Aids and appliances