Flashcards in Lec 85 Deck (11)
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
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
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"
What is dragging monoparetic gait?
leg is dragged like sack of potatoes
no external rotation or circumduction, normal reflexes no babinski
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
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
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
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
What is psychogenic tremor?
disappears with distraction and worse with observation
variable freq more likely psychogenic than variable amplitude
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