How do you explain neurological symptoms with no obvious cause?
In a postgraduate medical exam half a century ago, I was given a patient with a paralysed leg to examine. Was the paralysis organic (caused by physical disease) or was it functional – psychological, the result of neurosis or even of dissembling? The main examiner demanded that I say which. But I replied that the lady was still under investigation after several months, so that I could hardly be expected to decide the matter in ten minutes. The main examiner was furious, but the others laughed and said my point was well made, and they passed me. What clinched it was that I recognised Charcot’s oedème blue, blue oedema, in the affected leg, a rare condition caused by the patient’s deliberate application of a tourniquet to a limb. But just because she had done this, it did not mean her paralysis was what is usually called hysterical. Functional Neurological Disorder...
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