Approach to neurological symptoms

- Parkinson: 50-60% have depression compared to patients with spinal injury might have less
depression therefore the dep comes itself with the package of the disease
- Terminology: Conversion – Dissociative seizure/motor disorder – Hypochondriasis
- Terminology: Factitious – Munchausen syndrome – Malingering

1. Make a list of all the symptoms

2. Dissociative symptoms: Depersonlization/Dereal and Dizziness (spaced out/I’m here and not
here>unreal)
3. Look for other functional symptoms: Diarrhea/vomt/cough
4. Ask the patient what they think it is wrong

Case 1: Inner trembling with movement – Surface EMG recording done and it was found to have
Orthostatic tremor, started on Neurontin and had partial relief of her symptoms.

Case 2: Right handed man> left sided weakness, non-fluent aphasia, N cranial nerves, N brain CT

>>>Several panic attacks on the floor, was found to have Psychogenic weakness “limb doesn’t belong
to me” “limb not here” (Give-way weakness+ dragging gait+ Hoover sign+ hip abductor sign)

Case 3: Left sided weakness, left hemianopsia, left sided sensory loss and neglect, CT revealed
hematoma

>>>Found to have asomatognosia: denial the ownership of the arm

Somatoparaphrenia

Psychogenic tremor: improvement with distractions

Clinical features: - Variable frequency, variable amplitude (found in organic tremor), distractibility,
ballistic movements (tremor briefly stops), attempted immobilization (makes tremor worse),
entrainment test

Unconscious inference: conclusions based on previous experience

Case 4: Headache followed by blindness, normal pupillary reflex, symptoms resolved 24h after
delivery, found to have eclampsia (edema behind lateral geniculate body)

>>Posterior reversible leukoencephalopathy

You test for prioception which doesn’t need to be able to see…patients tend to fake it…

Optokinetic nystagmus: they are able to see

Case 5: Right orbital trauma, no light perception, monocular visual loss, normal pupillary reflex..

If pre-chiasma injury>> abnormal pupillary reflex>>Malingering + True orbital injury (abnormal

EMG)

Case 6: Blindsight (Cortically blind patients have preserved ability to react to visual stimuli despite
the lack of any conscious visual perception.
- Anton’s Syndrome: Denial of loss of vision (visual anosognosia) associated with confabulations
- Opsoclonus: saccadomania