Functional Neurological Disorder Flashcards
Symptoms of functional limb weakness
Heaviness on one side
Dropping things- lack of coordination/strength
Limb feels abnormal / detached
What conditions may functional limb weakness mimic?
Stroke
Multiple Sclerosis
Indications of functional disorder
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
What is Hoover’s sign?
Patient cannot push foot of affected limb into bed
Lift unaffected limb, power returns to affected to keep foot flat
What is a typical sign of Multiple Sclerosis in patient’s gait?
Swinging of leg
Symptoms that can accompany functional weakness
Low mood
Frustraition
Anxiety
Worry
4 Situations that may lead to functional weakness arising
After trauma or in pain
Illness with faitgue and/ bed rest
Waking up from anaesthetic/ arising from sleep
After episode of dissociation/ panic attack
What is complex regional pain syndrome?
Pain in one or more limbs occurring after physical injury or minor soft tissue issues eg. carpal tunnel
Diagnostic criteria for Complex Regional Pain Syndrome
Budapest
Describe the 4 points of the Budapest Criteria
- Continued pain that is disproportionate to the inciting event
- 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) - 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)
- There is no other diagnosis that better explains the signs and symptoms
What is allodynia?
Painful response to non-painful stimulus, eg. brushing hair
What is sudomotor activity?
Change in blood flow or skin colour
Other names for dissociative attacks
Non-epileptic seizures
Dissociative seizures
Psychogenic seizures
Functional seizures/attacks
What condition can dissociative attacks mimic?
Epilepsy
Two main types of dissociative attack
With movement - thrashing, like generalised seizure
Without movement- fall to ground, motionless, unresponsive for several minutes
Specific features of dissociative attack
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
Key indiciations in diagnosis of dissociative attack
Normal EEG
Normal scans
4 Categories of how dissociative attacks occur
- At random
- At rest, not distracted
- With hyperventilation
- With depersonalisation, derealisation
Describe 4 common Functional Sensory symptoms
- Altered sensation down one side - face, arm leg, (hemisensory syndrome)
- Feeling that limb doesn’t belong
- Fleeting sensations - twitches, buzzing, electric shock
- Visual - intermittent blurring, double vision, weakness
Which side is more commonly affected by functional sensory symptoms?
Left
How are functional sensory symptoms diagnosed?
Mainly on history taken by neurologist
Examine - some weakness and reduced sensation
Tests and scans normal
Five situations in which functional sesnory symptoms may arise
After injury/with pain With hyperventilation After illness with fatigue /bed rest After an episode of dissociation, panic attack Migraine No obvious cause
4 main symptoms of Functional movement disorders
Tremor
Jerks/twitches
Spasm/contractures
Gait problems
5 features of functional tremor
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
How is functional myoclonus characterised?
Jerks in anitcipation of loud noise
Presence of brainwave - Bereitschaftpotential
Describe benign twitches
Twitches common to eye and fingers, frequency increased in individuals with functional disease. Common in doctors and medical students who believe they have MND
Where do functional spasms most commonly occur
Wrists and hands
Which spasm is likley to occur during hyperventilation?
Carpopedal spasm
In which other condition does carpopedal spasm occur?
Low calcium
Describe functional dystonia
Position that is fixed - usually hands or feet
Associated with weakness of limb and pain
5 types of functional gait disorder
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
Why might functional movement disorders occur?
Commonly associated with injury or pain
Physiotherapy techniques for functional tremor
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
What is chronic fatigue syndrome?
Persisting tiredness with no other neurological symptoms, longer than 6 months. Not due to a detectable underlying medical or neurological condition
Locations of pain in patients with functional neurological symptoms
Back pain
Neck pain
Widespread joint and muscle pain - fibromyalgia; especially with faitgue and unrefreshing sleep
Complex Regional Pain
Functional Cognitive Disorder
Issue with memory or concentration not caused by disease or damage to the brain
Symptoms of functional cognitive disorder
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
Functinal speech and swallowing symptoms
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
