Evaluation of Neurologic Deficit Without Apparent Cause: The Importance of a Multidisciplinary Approach

When a patient presents with a neurological deficit without a clear cause, it creates a diagnostic puzzle for doctors. It's essential to rule out any physical issues that could be causing the symptoms before considering psychological factors. In cases of atypical paralysis, doctors often consider conversion disorder, where psychological stress manifests as physical symptoms. However, mood disorders are actually more common and can also lead to unusual symptom reporting. Malingering involves intentionally faking or exaggerating symptoms for personal gain, such as obtaining medications or avoiding work. This differs from factitious disorder, where individuals voluntarily assume the role of a sick person without external incentives.

• 1
  A thorough clinical examination and appropriate diagnostic studies can confidently exclude organic disorders when evaluating atypical paralysis.
• 2
  Neurophysiologic testing, such as SSEPs and MEPs, can reveal a functioning cerebral-spinal axis, suggesting a non-organic component to the paralysis.
• 3
  Functional MRI (fMRI) studies have shown that in patients with conversion disorder, there may be decreased activation of the basal ganglia and thalamus, disrupting the brain's motor control pathways.