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Neuro > Functional Neurological Disorder > Flashcards

Functional Neurological Disorder Flashcards

1
Q

Symptoms of functional limb weakness

A

Heaviness on one side
Dropping things- lack of coordination/strength
Limb feels abnormal / detached

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2
Q

What conditions may functional limb weakness mimic?

A

Stroke

Multiple Sclerosis

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3
Q

Indications of functional disorder

A 
Normal tests and scans
Pattern
No change in reflexes
Collapsing weakness
Hoover's sign
Dragging of affected leg
Difference in power when on the bed versus walking
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4
Q

What is Hoover’s sign?

A

Patient cannot push foot of affected limb into bed

Lift unaffected limb, power returns to affected to keep foot flat

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5
Q

What is a typical sign of Multiple Sclerosis in patient’s gait?

A

Swinging of leg

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6
Q

Symptoms that can accompany functional weakness

A

Low mood
Frustraition
Anxiety
Worry

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7
Q

4 Situations that may lead to functional weakness arising

A

After trauma or in pain
Illness with faitgue and/ bed rest
Waking up from anaesthetic/ arising from sleep
After episode of dissociation/ panic attack

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8
Q

What is complex regional pain syndrome?

A

Pain in one or more limbs occurring after physical injury or minor soft tissue issues eg. carpal tunnel

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9
Q

Diagnostic criteria for Complex Regional Pain Syndrome

A

Budapest

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10
Q

Describe the 4 points of the Budapest Criteria

A
  1. Continued pain that is disproportionate to the inciting event
  2. One symptom from three of the four following categories
    - Sensory; hyperesthesia, allodynia
    - Sudomotor; edema , and or sweating changes, and or sweating assymetry
    - Vasomotor; temperature changes, and or skin colour changes, and or skin colour assymetry
    - Motor/trophic; decreased range of motion, and or motor dysfunction(weakness, tremor, dystonia) and or trophic changes (nails, hair)
  3. Must display at least one sign at time of evaluation in two or more of the following categories:

Sensory: evidence of hyperalgesia (to pinprick) and/or allodynia (to light touch and/or deep somatic pressure and/or joint movement)

Vasomotor: evidence of temperature asymmetry and/or skin color changes and/or asymmetry

Sudomotor/edema: evidence of edema and/or sweating changes and/or sweating asymmetry

Motor/trophic: evidence of decreased range of motion and/or motor dysfunction (weakness, tremor, dystonia) and/or trophic changes (hair, nail, skin)

  1. There is no other diagnosis that better explains the signs and symptoms
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11
Q

What is allodynia?

A

Painful response to non-painful stimulus, eg. brushing hair

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12
Q

What is sudomotor activity?

A

Change in blood flow or skin colour

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13
Q

Other names for dissociative attacks

A

Non-epileptic seizures
Dissociative seizures
Psychogenic seizures
Functional seizures/attacks

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14
Q

What condition can dissociative attacks mimic?

A

Epilepsy

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15
Q

Two main types of dissociative attack

A

With movement - thrashing, like generalised seizure

Without movement- fall to ground, motionless, unresponsive for several minutes

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16
Q

Specific features of dissociative attack

A

Long duration
Abnormal movements of head and limbs
Prolonged period of unresponsiveness
Appearance of eyes and mouth during attack
Warnings
Patient finds it more difficult to describe attacks

17
Q

Key indiciations in diagnosis of dissociative attack

A

Normal EEG

Normal scans

18
Q

4 Categories of how dissociative attacks occur

A
  1. At random
  2. At rest, not distracted
  3. With hyperventilation
  4. With depersonalisation, derealisation
19
Q

Describe 4 common Functional Sensory symptoms

A
  1. Altered sensation down one side - face, arm leg, (hemisensory syndrome)
  2. Feeling that limb doesn’t belong
  3. Fleeting sensations - twitches, buzzing, electric shock
  4. Visual - intermittent blurring, double vision, weakness
20
Q

Which side is more commonly affected by functional sensory symptoms?

A

Left

21
Q

How are functional sensory symptoms diagnosed?

A

Mainly on history taken by neurologist
Examine - some weakness and reduced sensation
Tests and scans normal

22
Q

Five situations in which functional sesnory symptoms may arise

A 
After injury/with pain
With hyperventilation
After illness with fatigue /bed rest
After an episode of dissociation, panic attack
Migraine
No obvious cause
23
Q

4 main symptoms of Functional movement disorders

A

Tremor
Jerks/twitches
Spasm/contractures
Gait problems

24
Q

5 features of functional tremor

A

Tremor disappears transiently
Changes in rhythm when copying with unaffected/good limb - Entrainment test
Difficulty making rhythmical movements with good hand/leg
Times when tremor absent
Variable frequency
Tremor gets worse when someone tries to hold limb still

25
Q

How is functional myoclonus characterised?

A

Jerks in anitcipation of loud noise

Presence of brainwave - Bereitschaftpotential

26
Q

Describe benign twitches

A

Twitches common to eye and fingers, frequency increased in individuals with functional disease. Common in doctors and medical students who believe they have MND

27
Q

Where do functional spasms most commonly occur

A

Wrists and hands

28
Q

Which spasm is likley to occur during hyperventilation?

A

Carpopedal spasm

29
Q

In which other condition does carpopedal spasm occur?

A

Low calcium

30
Q

Describe functional dystonia

A

Position that is fixed - usually hands or feet

Associated with weakness of limb and pain

31
Q

5 types of functional gait disorder

A

Excessive slowness
Walking on ice pattern - cautious, feet far apart, legs stiff
Crouching - associated fear of falling
Sudden knee buckling - functional weakness in leg common finding
Unsteady, sudden sidesteps

32
Q

Why might functional movement disorders occur?

A

Commonly associated with injury or pain

33
Q

Physiotherapy techniques for functional tremor

A

Introduce a voluntary tremor
Interfere with rhythm of tremor - someone make tapping movement to copy; change rhythm so hard to follow - if tremor correlates with external rhythm, try manipulate into stopping

Breaking habit - pattern- in the brain

34
Q

What is chronic fatigue syndrome?

A

Persisting tiredness with no other neurological symptoms, longer than 6 months. Not due to a detectable underlying medical or neurological condition

35
Q

Locations of pain in patients with functional neurological symptoms

A

Back pain
Neck pain
Widespread joint and muscle pain - fibromyalgia; especially with faitgue and unrefreshing sleep
Complex Regional Pain

36
Q

Functional Cognitive Disorder

A

Issue with memory or concentration not caused by disease or damage to the brain

37
Q

Symptoms of functional cognitive disorder

A

Going blank
Losing track while doing things or in conversation
Mental fuzziness/sluggishness
Misplacing things - keys, phone
Forgetting periods of time - autopilot
Forgetting details of books or film or holidays
Forgetting words that seem on tip of tongue

38
Q

Functinal speech and swallowing symptoms

A 
Slurred speech
Stuttering speech
Word finding difficulty
Hoarse/Whispering speech
- Functional dysphonia
Functional aphonia (losing speech completely)
Foreign accent syndrome
Swallowing problems
- globus, globus pharyngis

Neuro (9 decks)

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