Title: Why Won't It Move? - Functional Neurologic Disorders<br/>Author: Danya Khoujah<br/><a href='http://umem.org/profiles/faculty/739/'>[Click to email author]</a><hr/><div style="font-family:'Helvetica Neue';font-size:14px;">
        <span style="font-size:12px;"><font face="Arial">Functional neurologic disorders, also referred to as psychogenic or nonorganic, comprise a significant part of neurological “emergencies”, and can be difficult to diagnose in the emergency department, leading to a significant over-utilization of resources.</font></span></div>
<div style="font-family:'Helvetica Neue';font-size:14px;">
        <span style="font-size:12px;"><span style="font-family: Arial;">Accurate diagnosis emphasizes on the presence of <b>positive physical signs</b> that are <b>internally inconsistent</b> or <b>incongruent with recognized disease</b>. The presence of an identifiable <b>stressor</b> is <b>not necessary</b> for diagnosis.</span></span></div>
<div style="font-family:'Helvetica Neue';font-size:14px;">
        <span style="font-size:12px;"><span style="font-family: Arial;">Exam findings may show:</span></span></div>
<div style="font-family:'Helvetica Neue';font-size:14px;">
        <span style="font-size:12px;"><span style="font-family: Arial;">a) Improvement of symptoms temporarily with focused attention on a different body part, such as:</span></span></div>
<div style="font-family:'Helvetica Neue';font-size:14px;">
        <span style="font-size:12px;"><font face="Arial">- Hoover sign and hip abductor sign for functional limb weakness</font></span></div>
<div style="font-family:'Helvetica Neue';font-size:14px;">
        <span style="font-size:12px;"><span style="font-family: Arial;">- Entrainment sign for functional tremor</span></span></div>
<div style="font-family:'Helvetica Neue';font-size:14px;">
        <span style="font-size:12px;"><span style="font-family: Arial;">- Improved standing balance with distractions</span></span></div>
<div style="font-family:'Helvetica Neue';font-size:14px;">
        <span style="font-size:12px;"><span style="font-family: Arial;">b) Clinical phenotype that is typical for the diagnosis, such as:</span></span></div>
<div style="font-family:'Helvetica Neue';font-size:14px;">
        <span style="font-size:12px;"><font face="Arial">- Eyes tightly shut while “unresponsive"</font></span></div>
<div style="font-family:'Helvetica Neue';font-size:14px;">
        <span style="font-size:12px;"><span style="font-family: Arial;">- Dragging gait with hips internally or externally rotated, with the forefoot remaining in contact with ground</span></span></div>
<div style="font-family:'Helvetica Neue';font-size:14px;">
        <span style="font-size:12px;"><span style="font-family: Arial;">- Fixed dystonic posture with ankle inversion and plantar flexion</span></span></div>
<div style="font-family:'Helvetica Neue';font-size:14px;">
        <span style="font-size:12px;"><span style="font-family: Arial;">- Global weakness, affecting extensors and flexors equally</span></span></div>
<div style="font-family:'Helvetica Neue';font-size:14px;">
        <span style="font-size:12px;"><font face="Arial">- Unilateral facial weakness with platysma overactivity, jaw deviation and/or contraction of orbicularis oris.</font></span></div>
<div style="font-family:'Helvetica Neue';font-size:14px;">
        <span style="font-size:12px;"><font face="Arial">That being said, functional and organic disease may co-exist in some patients and it may be worthwhile to refer them to a neurology clinic for possible further workup.</font></span></div>
<p>
        <span style="font-size:12px;"><!--?xml version="1.0" encoding="UTF-8" standalone="no"?--></span></p>
<div style="font-family:'Helvetica Neue';font-size:14px;">
        <span style="font-size:12px;"><span style="font-family: Arial;">The original article has links to multiple videos demonstrating those signs. It can be accessed on </span><a href="http://journals.lww.com/continuum/Abstract/2015/06000/Functional_Neurologic_Disorders.22.aspx">h</a><a href="http://journals.lww.com/continuum/Abstract/2015/06000/Functional_Neurologic_Disorders.22.aspx">ttp://journals.lww.com/continuum/Abstract/2015/06000/Functional_Neurologic_Disorders.22.aspx</a><span style="font-family: Arial;"> </span></span></div>
<div style="font-family:'Helvetica Neue';font-size:14px;">
         </div>
<fieldset><legend>References</legend>

                <p>
        <!--?xml version="1.0" encoding="UTF-8" standalone="no"?--><span style="font-family: 'Courier New';font-size:14px;"><span style="font-family: Arial;"><span style="font-size: 18px;">Stone J, Carson A. <b>Functional Neurologic Disorders.</b> Continuum 2015;21(3):818–837</span></span></span></p>
</fieldset>