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Flashcards in Lec 85 Deck (11)
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1

What factors suggest non-neuro cause for disease?

- history of anxiety, depression, panic attacks
- multiple somatic complaints
- history of stress related disorders or other poorly defined medical syndromes [like irritable bowel, chronic fatigue, chronic lyme]
- inconsistencies on physical exam

2

What are some pseudo-neurologic motor symptoms that may be seen in conversion disorder?

- abnormal movements
- movements worse when calling attention or light touch
- wildly ataxic
- paralysis/paresis of one or more limbs without confirming to neural paths/distribution
- normal reflexes
- co-contraction of muscles
- normal strength

3

What does the arm drop test tell you?

- determine if non-organic weakness

if somatic/functional =
- hold pts affected arm above face and arm is dropped
- if non-organic/functional --> paralyzed arm will have "jerky descent" and not strike the patient's face "near miss"

4

What is dragging monoparetic gait?

leg is dragged like sack of potatoes
no external rotation or circumduction, normal reflexes no babinski

5

What is hoover's sign?

based on principle that flexion at one hip is accompanied by involuntary extension of contralateral joint

-- examiner holds hand under "weak" limb and asks patient to flex contralateral hip against resistance

if non-organic weakness --> involuntary extension of paralyzed leg occurs when flexing contralateral leg against resistance
= positive Hoover sign

if no pressure felt = more likely organic limb weakness

6

What are common sensory symptoms of non-organic disease

anesthesia and paresthesia especially extremities

suspicious if do not follow distribution of neuro deficit, sensation split exactly at midline

7

What happens in gait disorders of non-organic disease?

gait disorders rapid onset, significant variability, improvement with distraction and worse with attention

has "gait problems" but does not injure him/herself

8

What is astasia-abasia?

unusual and dramatic gait disturbance where patient lurches wildly in various directions and nearly falls only when someone or something nearby to catch them

9

What is psychogenic tremor?

disappears with distraction and worse with observation

variable freq more likely psychogenic than variable amplitude

10

What blindness in functional disease?

psychogenic complete blindness = unable to bring their fingers together and unable to sign their name [thought individuals who are truly blind can do both]

- normal pupil reaction

11

What is psychogenic non-epileptic seizures [PNES]?

women > men
20-30 yo most common groups
seen in cases of physical/sexual abuse
side to side head or body turning "jactation"
seizures tend to slow down at end

eyes closed clenched mouth