PMC full text:
Published online May-Jun 2015.
TABLE 3
| SYMPTOM | DISTINGUISHING FEATURES AND PRESENTATION |
|---|---|
| Blindness | In conversion disorder, the patient, though complaining of recent onset of blindness, neither sustains injury while maneuvering around the office nor displays any expected bruises or scrapes. The pupillary reflex is present, thus demonstrating the intactness of the optic nerve, chiasm, tract, lateral geniculate body, and mesencephalon. |
| Deafness | In conversion deafness, the blink reflex to a loud and unexpected sound is present, thus demonstrating the intactness of the brain stem. |
| Psychogenic nonepileptic seizures | Patients with psychogenic nonepileptic seizures generally lack response to treatment with antiepileptic drugs or have a paradoxical increase in seizures with antiepileptic drug treatment. The negative history of injury or loss of control of bladder or bowel during the seizure episode is also significant. |
| Tremor | When weights are added to the affected limb, patients with functional tremor tend to have greater tremor amplitude, whereas in those with organic tremor, the tremor amplitude tends to diminish. |
| Dystonia | Useful distinguishing features include an inverted foot or “clenched fist,” adult onset, a fixed posture that is apparently present during sleep, and the presence of severe pain. |
| Paralysis | In conversion paralysis, the patient loses the use of half of his or her body or of a single limb, but the paralysis does not follow anatomical patterns and is often inconsistent upon repeat examination. |
| Syncope | The conversion patient may report feeling faint or fainting, but no autonomic changes are identified, such as pallor, and there is no associated injury. In addition, the fainting spells have a “swooning” character to them, heightening the drama of these events. |
| Aphonia | Conversion aphonia may be suspected when the patient is asked to cough, for example, during auscultation of the lungs. In contrast with other aphonias, the cough is normally full and loud. |
| Anesthesia | Conversion anesthesia may occur anywhere, but it is most common on the extremities. One may see a typical “glove and stocking” distribution; however, unlike the “glove and stocking” distribution that may occur in a polyneuropathy, the areas of conversion anesthesia have a very precise and sharp boundary, often located at a joint. |
| Paraplegia | In conversion paraplegia, one finds normal, rather than increased, deep tendon reflexes, and the Babinski sign is absent. In doubtful cases, the issue may be resolved by demonstrating normal motor evoked potentials. |