Non-organic paresis and the Hoover sign

About 16 years ago, a patient had a spinal tap in our house and was discharged – we don’t know much about the details. After the deed she developed a hemiparese with hemianopsia and sensory disturbance, which led to an extensive workup in a university hospital and half a year of rehab.  Thereafter the patient was discharged in a wheelchair, then 33 years old. Since, she managed to work herself out of her wheelchair and – with the help of the pope – to walk again, still with a Wernicke man walk. In the meantime she seems to have been treated for bipolar disease, although again we don’t know much about the details. She is now on our ward for suspected basilar embolus and shows a highly suspicious hemiparesis without any Babinski or reflex difference.

We discuss some aspects of the clinical examination of hysterical paresis, focussing on the physiological coinnervations and particularly on Hoover’s sign, which we demonstrated in the patient.

As for functional / medically unexplained / non-organic symptoms in Neurology, there is a lot to think and talk about. I find the practical “british” approach of Stone’s school very attractive, so I highly recommend this article about diagnosis, it’s companion article about management of functional symptoms and the rest of Jon Stone’s articles in the JNNP and elsewhere.