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Conversion disorder:Diagnosis & evaluation

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Conversion disorder can present with any motor or sensory symptom in the body including:

Diagnosis depends not on the absence of findings of neurological disease but on the finding of positive evidence of conversion symptoms.

La belle indifférence has been described as a characteristic feature of conversion. It is characterized by the inappropriate and paradoxical absence of distress despite the presence of an unpleasant symptom. Patients often deny emotional difficulty. Traditionally associated with conversion disorder, la belle indifférence, histrionic personality, and secondary gain are clinical features that appear to have no diagnostic significance. Although presence of these features supports the diagnosis, they have no diagnostic validity because the diagnosis of conversion disorder ultimately depends upon clinical findings that clearly demonstrate that the patient's symptomatology is not caused by organic disease. [1]

One study reported 5 patients with hysterical conversion reactions after injury or infarction to the left cerebral hemisphere. [2]

Conversion symptoms are remarkably consistent between patients, just as Parkinson's disease is consistent between patients. There may be positive evidence of patterns of weakness (for example Hoover's Sign or a non-pyramidal pattern of weakness) or a typical gait problem (for example a 'dragging monoplegic gait). For Psychogenic non-epileptic seizures a range of features of the attacks must be taken in to consideration and the diagnosis may need confirmation with videotelemetry.

Diagnosis is not easy and should preferably only be made by a neurologist with experience of the condition.

Patients with conversion symptoms will typically have multiple other symptoms which may include fatigue, sleep disturbance, memory and concentration difficulties, pain (neck, back, muscles), bowel and bladder sensitivity

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