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Neurologic Emergencies pp 195–207Cite as

The Nonanatomic Exam: Psychogenic Syndromes and Malingering

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Abstract

A 21-year-old college student developed sudden right arm and leg weakness after a bout of unusually strenuous coughing while talking to her roommate about her recent “breakup” with her boyfriend. They had planned to go out that evening, but she changed plans on account of a migraine headache and neck discomfort that had developed during the day. Alarmed by her friend’s limp limbs, she called 911, and the EMS team arrived promptly, appropriately considered her to have a potential stroke syndrome, and sped to the nearest comprehensive stroke center. During the emergency vehicle transportation, she was able to speak fluently and comprehend all questions asked of her by the emergency personnel. They documented a blood pressure and pulse within normal range but a slight tachycardia at times between 90 and 110 per min, without pyrexia or oxygen desaturation. On arrival at the emergency department, she was triaged as a possible stroke patient, and emergency CT brain, glucose test, PT, PTT, platelet count, basal metabolic panel, and comprehensive metabolic panel were performed all of which were normal. She was examined briefly and found to be alert, rational, and fully conversant; power grading of the right arm was 1–2/5 and right leg 1–2/5 (flicker of movement and not able to overcome gravity) on the MRC scale. Reflexes were symmetrical in both arms and legs. She declined to attempt walking. She was considered for intravenous tissue plasminogen activator therapy by the emergency physician in consultation with the on-call neurologist. In the meantime, the nurse obtained additional history from the patient.

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Author information

Authors and Affiliations

  1. University of Central Florida, Orlando, FL, USA

    Michael Hoffmann M.D., Ph.D.

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  1. Michael Hoffmann M.D., Ph.D.
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Correspondence to Michael Hoffmann M.D., Ph.D. .

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Editors and Affiliations

  1. Orlando, Florida, USA

    Latha Ganti

  2. Boston, Massachusetts, USA

    Joshua N. Goldstein

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Hoffmann, M. (2018). The Nonanatomic Exam: Psychogenic Syndromes and Malingering. In: Ganti, L., Goldstein, J. (eds) Neurologic Emergencies. Springer, Cham. https://doi.org/10.1007/978-3-319-64523-0_10

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  • DOI: https://doi.org/10.1007/978-3-319-64523-0_10

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-64521-6

  • Online ISBN: 978-3-319-64523-0

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