- Clinical Professor of Neurosurgery, School of Medicine, State University of NY at Stony Brook, NY and c/o Dr. Marc Agulnick 1122 Frankllin Avenue Suite 106, Garden City, NY 11530, USA.
Nancy E. Epstein MD, Clinical Professor of Neurosurgery, School of Medicine, State University of NY at Stony Brook, NY and c/o Dr. Marc Agulnick 1122 Frankllin Avenue Suite 106, Garden City, NY 11530, USA.
DOI:10.25259/SNI_278_2022Copyright: © 2022 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Nancy E. Epstein. Review/perspective on hysterical paralysis: A diagnosis of exclusion for spinal surgeons. 29-Apr-2022;13:172
How to cite this URL: Nancy E. Epstein. Review/perspective on hysterical paralysis: A diagnosis of exclusion for spinal surgeons. 29-Apr-2022;13:172. Available from: https://surgicalneurologyint.com/surgicalint-articles/11572/
Background: Hysterical paralysis (HP) and/or conversion disorders (CD) are diagnoses of exclusion for spine surgeons. Before assigning this diagnosis to a patient, they must first undergo a full neurodiagnostic evaluation (i.e., X-rays, MR, CT/Myelo-CT) to rule out organic spinal pathology. Here, we reviewed select articles highlighting how to differentiate HP/CD patients from those with spinal disease.
Methods: Several case studies and small series of patients with HP/CD were included in our analysis. Notably, prior to being assigned the diagnoses of HP/CD, patients had to first undergo X-ray, MR, CT, and/or Myelo-CT evaluations to rule out spinal disorders; typically, their neurodiagnostic studies were normal.
Results: Patients with HP/CD often presented with varying clinical complaints of motor paralysis despite intact reflexes, normal sensory examinations, and lack of sphincter disturbance (i.e. intact rectal tone). Further, go and nogo functional MRI (fMRI) examinations demonstrated inconsistencies in areas of brain activation for patients with HP/CD complaints.
Conclusions: HP/CD are diagnoses of exclusion, and patients should first undergo a full panel of neurodiagnostic studies to rule out organic spinal disease. While those with HP/CD should not have unnecessary operations, those with real “surgical pathology” should have appropriate spine surgery performed in a timely fashion.
Keywords: Computed Tomography (CT), Conversion Disorder (CD), Diagnosis of Exclusion, Functional MRI (fMRI), Hysterical Paralysis, Magentic Resonance Imaging (MR/MRI)
Hysterical paralysis (HP) or conversion disorders (CF) are diagnoses of exclusion [
Maxion et al. (1989) identified multiple factors in patients with “classical conversion syndromes” and/or psychogenic seizures/paralysis [
In 2019, Blashfield analyzed 16 different classification systems using 22 common terms to describe psychological/ mental disorders that had been used since the 19th century [
Several studies highlighted how inconsistencies in clinical evaluations and ultimately normal neurodiagnostic studies helped differentiate between HP/CD vs. organic spinal disorders [
The incidence of HP/CD is 5-22/100,000 in the overall population. Here we have summarized how the diagnoses of HP/CD can be differentiated from organic spinal pathology [
Few papers focused on episodes of HP/CD “paralysis” immediately following spine surgery [
In 2012, Stone reported his own experience with transient psychogenic paralysis of a leg following a fall resulting in a torn quadriceps muscle [
fMRI, performed in patients with unexplained/inconsistent neurological deficits and normal neurodiagnostic studies, helped identify/differentiate patients with HP/CD vs. organic spinal disease [
The diagnoses of HP/CD are diagnoses of exclusion, and should not be established without first obtaining appropriate neurodiagnostic tests and other studies [
Patients should not be labeled with HP/CD paralysis until neurodiagnostic/other studies (i.e., variously including MR, CT-Myelo-CT, fMRI, SEP/EMG/ MEP) have ruled out the presence of organic disease.
Patient’s consent not required as there are no patients in this study.
There are no conflicts of interest.
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