Editorials

Medically unexplained neurological symptoms

BMJ 1998; 316 doi: https://doi.org/10.1136/bmj.316.7131.564 (Published 14 February 1998) Cite this as: BMJ 1998;316:564

The risk of missing organic disease is low

  1. Michael D O'Brien, Physician for nervous diseases
  1. Department of Neurology, Guy's Hospital, London SE1 9RT

    See p 582

    A psychological component exists in all illness, contributing a variable amount to the clinical presentation. At the benign end of this range are patients who describe their symptoms in more florid terms than seem to be justified. At the malignant end is malingering and the Munchausen syndrome. Between these extremes are a range of patients who present with non-organic signs or symptoms, with or without underlying neurological disease, usually called hysterical elaboration or hysterical conversion disorder.

    Again a range of clinical presentation exists. If patients present with apparent non-organic signs or symptoms and are later found to have an underlying disease which might account for some or most of their original problems this is perceived as a hysterical elaboration of the underlying deficit. For example, a patient who seems to have a hysterical paraplegia might be found to have white matter changes on magnetic resonance imaging and oligoclonal bands in the cerebrospinal fluid. Patients already known to have a neurological condition might develop non-organic signs or symptoms, sometimes related to the original condition, but often …

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