Neurology · MU Sofia

86. Neurosis with neurological symptoms

Covers functional neurological disorder, also called conversion disorder, where neurological symptoms arise without structural disease and are linked to psychological stress. It takes in pathogenesis, motor, sensory, speech and seizure-like presentations, and the clinical signs that point to a functional cause, including the Hoover sign. It then outlines examination, diagnostic investigations, differential diagnosis against stroke, epilepsy, multiple sclerosis and neuromuscular disorders, and management with communication, psychotherapy, physiotherapy and psychiatric care.

Inside: 1 section · 16 flashcards · 2 min

Topic 86 of 88 in the MU Sofia syllabus for Neurology (Medicine, Year 4). The free AceMed note covers it in 1 section, about 327 words (2 min of reading), with 16 flashcards.

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  1. Neurosis with neurological symptoms

Neurosis with neurological symptoms

Definition

Neuroses with neurological symptoms (modern term: functional neurological disorder / conversion disorder) are conditions in which patients present with neurological symptoms without structural neurological disease, caused by psychological conflict, stress, or subconscious mechanisms.

  • Symptoms are real to the patient, but no organic lesion is found.

Pathogenesis

  • Psychological stress or trauma
  • Conversion of emotional conflict into physical symptoms
  • Dysfunction of brain networks controlling movement, sensation, or consciousness
  • No detectable structural CNS/PNS damage

Clinical Features

Motor Symptoms: Weakness or paralysis (non-anatomical distribution) Abnormal gait (e.g., “dragging” or inconsistent patterns). Tremor (variable, distractible). Dystonia-like postures. Sudden inability to move a limb

Sensory Symptoms: Numbness with non-dermatomal distribution. “Glove and stocking” pattern without neuroanatomical basis. Visual disturbances (blurred vision, tunnel vision). Hearing loss without organic cause

Speech and Swallowing: Aphonia (loss of voice). Slurred speech. Globus sensation (“lump in throat”)

Seizure-like Episodes: Psychogenic non-epileptic seizures (PNES). No EEG epileptic activity during attacks. Asynchronous limb movements

Key Clinical Signs Suggesting Functional Disorder

1.Inconsistency: Symptoms vary during examination. Different findings in distraction vs formal testing

2.Non-anatomical distribution: Symptoms do not match neuroanatomical pathways

3.Hoover Sign (important for exam): Apparent leg weakness improves when contralateral leg is tested

4.Distractibility: Symptoms improve when attention is diverted

Examination

  • Neurological Examination: Normal reflexes or inconsistent reflexes. Normal muscle tone in many cases. No objective sensory level
  • Mental State: Anxiety or depression may be present. Emotional stress triggers often identified

Diagnosis

Clinical Diagnosis (key): Based on positive functional signs (not just exclusion)

Investigations

  • MRI brain/spine: normal
  • EEG: normal in PNES
  • EMG/NCS: normal

Differential Diagnosis

1. Stroke: Sudden onset, consistent deficits, imaging positive

2. Epilepsy: EEG abnormalities

3. Multiple Sclerosis: Objective CNS lesions

4. Neuromuscular disorders: EMG/NCS abnormalities

Management

1. Communication (very important): Explain diagnosis clearly and empathetically. Avoid suggesting “nothing is wrong”

2. Psychological Therapy: Cognitive behavioral therapy (CBT). Psychotherapy

3. Physiotherapy: Functional retraining. Gait rehabilitation

4. Psychiatric Treatment: Treat anxiety/depression if present

Prognosis: Variable. Better if early diagnosis and good therapeutic alliance. Chronic cases may persist

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