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Charcot's hysteria renaissant.

The authenticity of Charcot's original descriptions of hysteria has been questioned in the popular media. None the less, it is still possible to encounter florid forms of hysteria in culturally deprived communities, and to answer Charcot's present day critics we present a selection of patients from Kentucky's Appalachian countries with hysterial neurological disease. Their case histories are contrasted with those Charcot himself described and thereby form a modern commentary on such conditions as la grande hystérie, hysteroepilepsy, hysterotraumatic monoplegia, and hysterical hemianaesthesia.

Adolescent↗
PubMed1986

Successful rehabilitation in conversion paralysis.

A rehabilitation programme for patients with conversion paralysis has been introduced in which they are offered physical rehabilitation. During an eight month period between October 1984 and May 1985 six patients who had been diagnosed as dependent on wheelchairs owing to conversion paralysis for a mean of 3 years (range 1-6 years) were entered into the inpatient neurorehabilitation programme. All six patients were able to walk within a mean of 41 days (range 10-70 days), and then relinquished a variety of aids and allowances as a result of their regained mobility. They continued to be independent at outpatient review for a mean of 10 months (range 8-15 months). Successful rehabilitation from wheelchair dependency can be achieved by a cost effective, prolonged, inpatient neurorehabilitation programme.

Adolescent↗
PubMed2005

Systematic review of misdiagnosis of conversion symptoms and "hysteria".

OBJECTIVE: Paralysis, seizures, and sensory symptoms that are unexplained by organic disease are commonly referred to as "conversion" symptoms. Some patients who receive this diagnosis subsequently turn out to have a disease that explains their initial presentation. We aimed to determine how frequently this misdiagnosis occurs, and whether it has become less common since the widespread availability of brain imaging. DESIGN: Systematic review. DATA SOURCES: Medline, Embase, PsycINFO, Cinahl databases, and searches of reference lists. REVIEW METHODS: We included studies published since 1965 on the diagnostic outcome of adults with motor and sensory symptoms unexplained by disease. We critically appraised these papers, and carried out a multivariate, random effect, meta-analysis of the data. RESULTS: Twenty seven studies including a total of 1466 patients and a median duration of follow-up of five years were eligible for inclusion. Early studies were of poor quality. There was a significant (P < 0.02) decline in the mean rate of misdiagnosis from the 1950s to the present day; 29% (95% confidence interval 23% to 36%) in the 1950s; 17% (12% to 24%) in the 1960s; 4% (2% to 7%) in the 1970s; 4% (2% to 6%) in the 1980s; and 4% (2% to 6%) in the 1990s. This decline was independent of age, sex, and duration of symptom in people included in the studies. CONCLUSIONS: A high rate of misdiagnosis of conversion symptoms was reported in early studies but this rate has been only 4% on average in studies of this diagnosis since 1970. This decline is probably due to improvements in study quality rather than improved diagnostic accuracy arising from the introduction of computed tomography of the brain.

Adolescent↗
PubMed1994

Globus pharyngeus: radiographic evaluation and 24-hour pH monitoring of the pharynx and esophagus in 22 patients.

PURPOSE: The authors correlated the radiographic evaluation and 24-hour pH monitoring of the pharynx and the esophagus in patients with globus pharyngeus. MATERIALS AND METHODS: Radiographic examination of the pharynx of 22 patients (13 women and nine men, aged 23-73 years [mean, 47 years]) included videofluoroscopy and static radiography. Twenty-four-hour double-probe pH monitoring of the pharynx (abnormal, pH < 4) and esophagus (abnormal, 6% or more total acid exposure) was performed in all patients. RESULTS: Radiographic results were normal in 17 patients; results were abnormal in five, with four having pharyngeal dysfunction and one showing a persistent cricopharyngeal impression. Zenker diverticulum was not seen. Results at pH monitoring of the pharynx and esophagus were normal in 20 and 18 of the 22 patients, respectively. In four of five patients with abnormal radiographic studies of the pharynx, results of pharyngeal pH monitoring were normal. CONCLUSION: Most patients with globus pharyngeus had normal results at pH monitoring and radiographic examination of the pharynx.

Adult↗