Unexplained Symptoms in Neurology Flashcards
How should you approach neurological symptoms?
Is there something wrong with the nervous system?
If so:
- Where is it? (symptoms etc)
- What is it? (investigation)
Diagnosis:
-This predicts prognosis and management
Are unexplained symptoms common?
Yes. Extremely
Not just in neurology:
- GP 50% patients
- Neuro not quite that high
Give some examples of common unexplained symptoms
Poor memory Poor concentration Headaches Altered sense of smell Altered sense of taste Tinnitus Dizziness Funny turns fatigue Weakness Tingling Pain
What are the two situations for unexplained symptoms?
Situation 1
- Symptoms
- No signs
- Normal investigations
- (No proof of any underlying pathology)
Situation 2
- Symptoms severe
- Abnormal signs seem minor
- Abnormal investigations seem minor
- (Known pathology fails to explain symptoms)
What are unexplained symptoms likely to be a disturbance of?
Mood
Emotion
Behaviour
Describe the sick role
Rights:
- Exemption from normal social roles
- Not held responsible for their condition
Obligations:
- Should get well
- Should accept medical advice
Describe illness behaviour
Symptom perception Symptom significance Communication Consultation behaviour Treatment compliance Maintenance of usual activities Mood
What did the Scottish Neurological Symptoms Study find in 2003?
Patients with “unexplained” symptoms were:
- More likely to be not working
- More likely to be receiving benefits
How may physical problems effect psychological problems?
Physical disease -> Psychological symptoms
- HD causing behavioral disturbance
- Cerebral lupus causing psychosis
Physical diagnosis -> Psychological reaction
-Depression after diagnosis of MS
How may Psychological problems effect physical problems?
Psychological disturbance -> increased physical problem (inc pain)
-Adverse left event triggers depression which worsens pre-existing migraine
Psychological disturbance -> unexplained symptoms
-Someone with chronic anxiety and depression complains of unexplained weakness and fatigue
What are some of the physical manifestations of anxiety?
Autonomic:
-e.g. sweating, palpitations, tingling, dizziness, nausea, diarrhoea, urinary frequency
Increased motor tone:
-e.g. trmor, muscle pain, tiredness, dysphagia
Hyper-vigilance:
-e.g. Irritability, poor concentration, insomnia, easily startled
What do physical manifestations of depression include?
Sleep Weight Appetite Libido Energy levels Posture Pain perception
What is hypochondriasis?
Preoccupation with disease
Fear of illness
Persistent belief of unidentified disease
Request for repeated reassurance
Request for repeated investigation
What is Somatisation disorder?
- Example of “abnormal illness behaviour”
- Chronic
- Onset before 30
- Multiple unexplained physical symptoms
- Thick notes
- Multiple hospital visits
What is Conversion disorder?
- Used to be called “hysteria”
- Loss of function of a body part
- Signs mimic neurological disease
- Inconsistent signs
- Patient not conscious of mechanisms
- Information from functional imaging
