Cases reported "Paralysis"

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1/17. Imaging hypnotic paralysis: implications for conversion hysteria.

    In a single case study with positron emission tomography (PET) functional imaging, hypnotic paralysis activated similar brain areas to those in conversion hysteria, supporting the view that hypnosis and hysteria might share common neurophysiological mechanisms.
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ranking = 1
keywords = conversion, hysteria
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2/17. The voluntary control of motor imagery. Imagined movements in individuals with feigned motor impairment and conversion disorder.

    The ability to volitionally control motor imagery was investigated by comparing the chronometry of real and imagined movements in a patient (AB) with conversion disorder who presented with paralysis of the left arm and hand and in a patient (MM) with an actual injury to the left arm. Control experiments investigated voluntary control of motor imagery in a group of healthy individuals who feigned a motor impairment with one limb and in one group who were instructed to move carefully and slowly. The visually guided pointing task was used to investigate the speed for accuracy trade-offs that occur as target size is varied for both real and imagined performance. In the healthy individuals, the speed for accuracy trade-off for both real and imagined performance on the motor task conformed to Fitts' law provided both the speed and accuracy of movements was emphasised. In MM, real and imagined performance was also within normal limits despite considerable pain and discomfort. In AB and in subjects feigning a motor impairment, motor task performance with the affected limb was slow and did not conform to Fitts' law. However, although imagined performance with the affected limb was generally slower than with the unaffected limb, it did conform to Fitts' law. These results suggest subjects cannot anticipate the effects of an actual limb injury. Furthermore, while they are able to control the general duration of imagined movements they have little voluntary control over their relative timing.
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ranking = 6.058249051485
keywords = conversion disorder, conversion
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3/17. Hysterical paralysis: a report of three cases and a review of the literature.

    STUDY DESIGN: Three cases of hysterical paralysis are reported and the literature is reviewed. OBJECTIVE: To report and discuss three cases of psychogenic paraplegia in order to increase the awareness and assist in the diagnosis and treatment of this uncommon disorder. SUMMARY OF BACKGROUND DATA: Hysterical paralysis, a form of conversion disorder, is an uncommon psychogenic, nonorganic loss of motor function precipitated by a traumatic event. The prevalence of conversion disorder in the general population reportedly is between 5 and 22 per 100,000 persons. The pursuit of a diagnosis for the hysterical paraplegic patient necessarily consumes valuable resources and time. If early recognition can be facilitated, these resources may be conserved. methods: The medical records for three healthy young women who presented to the authors' service reporting complete loss of lower extremity function were reviewed retrospectively along with the related laboratory, electrodiagnostic, and imaging studies. Two of the women were involved in motor vehicle accidents. One had a history of a previous hysterical seizure. Inconsistencies in physical examination and studies were noted. RESULTS: All three patients had normal laboratory, electrodiagnostic, and imaging studies. Discrepancies included complete loss of motor control and sensation in the lower extremities in the face of normal deep tendon reflexes as well as incontinence of bowel and bladder despite intact rectal tone. The patients spontaneously recovered and ambulated out of the hospital without assistance after their normal test results and physical examination inconsistencies were presented to them. CONCLUSIONS: Hysterical paraplegia is a type of conversion disorder. It is a diagnosis of exclusion that typically presents as mono-, hemi-, para-, or quadriplegia. The pursuit of a diagnosis for the hysterical paraplegic patient necessarily consumes valuable resources and time. The typical patient is a female from a low socioeconomic background with limited education. The DSM-IV-TR criteria must be met to fulfill the diagnosis of conversion disorder. Electrodiagnostic and imaging studies can aid in the diagnosis. Treatment revolves around explaining the normal diagnostic results to the patients and guiding them to appropriate psychiatric and physiotherapy. Rapid recovery should be expected, but can take up to 6 months.
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ranking = 5.930396803785
keywords = conversion disorder, conversion
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4/17. Motor sensory dysfunction of upper limb due to conversion syndrome.

    Seven patients had functional paralysis that occurred in the dominant limb together with joint contracture and sensory disturbances associated with emotional problems. In five of these patients, the syndrome was preceded by trauma to the affected upper limb and in one patient by a myocardial infarction. The treatment consisted of persuasion, suggestion, general rhythmic exercises and emotional support given by the physiatrist (not a psychiatrist). In five of the subjects treated, the symptoms disappeared and the patients soon returned to work. In two patients the treatment did not succeed since no satisfactory rapport could be established between the patient and the physician.
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ranking = 0.5114089907999
keywords = conversion
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5/17. transcranial magnetic stimulation in the reversal of motor conversion disorder.

    BACKGROUND: There is no agreement on the most effective therapy for motor conversion symptoms. Functional electric stimulation has been successfully used to reverse conversion paralysis. We tested the therapeutic potential of high-frequency repetitive transcranial magnetic stimulation (rTMS) in a 20-year-old patient suffering from a conversion paralysis of the right arm. METHOD: rTMS was applied to the contralateral motor cortex. Stimulations were performed on working days at a frequency of 15 Hz (train length 2 s; inter-train interval 4 s) yielding 4,000 pulses/day. RESULTS: Within 12 weeks, motor function, hyposensibility and muscle bulk were completely restored. CONCLUSIONS: The patient recovered completely during rTMS treatment. In addition to possible psychological effects, rTMS may have had a causal therapeutic effect by strengthening corticocortical connections and thereby priming voluntary movements. Further controlled studies are needed.
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ranking = 6.3139535468849
keywords = conversion disorder, conversion
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6/17. The misdiagnosis of conversion disorder in a psychiatric emergency service.

    During a 1-year period, 8400 patient presentations to a psychiatric emergency service were screened for the conversion symptom of extremity paresis/paralysis. Of 4220 unduplicated presentations, three patients had this complaint. These cases were reviewed and followed up. All had received a DSM-III diagnosis of conversion disorder, but in each case the patient's conversion symptom was attributed to organic disease. This had medicolegal consequences in one case and threatened legal consequences in the others. Although the frequency of this alleged conversion symptom was 0.07%, in reality it was 0.0%. Guidelines for the management of the alleged conversion symptom of paresis/paralysis are discussed.
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ranking = 7.9244049955311
keywords = conversion disorder, conversion
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7/17. Conversion reactions in pediatric athletes.

    We report five children and adolescents who displayed a conversion reaction in response to stresses induced by athletic competition. Failure to make proper diagnosis led to additional physician referral, needless testing, rehabilitation, or orthotic management. patients are characterized as high achievers who are frequently younger than peers in the sport. Conversation between child and physician identified the source of conflict in four patients. Physical therapy helps resolve symptoms associated with an acute episode and facilitates transition into psychotherapy. psychotherapy is recommended only for patients with persistent maladaptive behavior.
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ranking = 0.12785224769997
keywords = conversion
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8/17. Successful rehabilitation in conversion paralysis.

    A rehabilitation programme for patients with conversion paralysis has been introduced in which they are offered physical rehabilitation. During an eight month period between October 1984 and May 1985 six patients who had been diagnosed as dependent on wheelchairs owing to conversion paralysis for a mean of 3 years (range 1-6 years) were entered into the inpatient neurorehabilitation programme. All six patients were able to walk within a mean of 41 days (range 10-70 days), and then relinquished a variety of aids and allowances as a result of their regained mobility. They continued to be independent at outpatient review for a mean of 10 months (range 8-15 months). Successful rehabilitation from wheelchair dependency can be achieved by a cost effective, prolonged, inpatient neurorehabilitation programme.
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ranking = 0.76711348619985
keywords = conversion
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9/17. The utility of electromyographic biofeedback in the treatment of conversion paralysis.

    Conversion paralysis has a poor prognosis when there is evidence of nonresponse to previous treatment, long duration, and secondary atrophy of the "paralyzed" muscles. The authors present four such cases in which conversion paralysis was treated successfully by means of electromyographic (EMG) biofeedback. Each of the four patients also suffered from a chronic pain condition. Results from statistical analyses indicated that the four patients demonstrated significant improvement in the functional capacity of the "paralyzed" muscles as measured by isometric maximum voluntary contraction and EMG activity. The improvements occurred without explicit psychotherapy and suggest that behavioral modification techniques alone may be helpful in such cases.
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ranking = 0.63926123849987
keywords = conversion
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10/17. Functional electric stimulation in the reversal of conversion disorder paralysis.

    Numerous reports have documented the usefulness of functional electric stimulation (FES) in restoring and/or improving the function of organically diseased or paralyzed muscles. There are few reports related to the use of FES in the treatment of conversion disorder paralysis of the hysterical type. This paper presents a case of hysterically paralyzed muscles where the patient received daily treatment with FES for two weeks. Electric current was applied to a weak quadriceps and to paralyzed tibialis anterior muscles. This electrotherapeutic modality was effective in improving the function of the quadriceps and in reversing the paralysis of the tibialis anterior muscles. The improvement in the muscles' functional abilities was documented through the use of quantitative measures of muscle strength as well as computerized analysis of EMG signals. The results showed that the administration of FES resulted in a dramatic increase in motor units recruitment, increased muscle strength, and improved voluntary muscle control.
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ranking = 7.4129960047312
keywords = conversion disorder, conversion
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