01-23-2009, 10:01 PM
The correct answer is C. Conversion disorder is characterized by deficits in sensory and/or motor function that suggest a neurologic etiology for the presenting deficits. However, physical examination with detailed neurological evaluation, as well as laboratory and radiographic data, fail to support a neurologic cause for the presentation. This patient reports inability to use his right leg, but neurologic exam reveals normal reflexes and a normal Babinski. Additionally, the motor and sensory deficits do not conform to known anatomic pathways. Hoover's sign is also helpful in diagnosing psychogenic hemiparesis. With the patient lying supine, one can judge the effort put forth in the lower extremities by placing one hand between the heel and the examining table while testing the ability of the patient to raise the other leg off the table. With full effort the heel on the table is forced downward to support the raising of the opposite leg. When full effort is used to raise the good leg, one can feel the normal downward pressure of the "weak" leg. When the weak leg is supposed to be raised, one may feel very little if any pressure under the leg with presumably normal strength indicating that the patient is not trying to raise the weak leg. In fact, the pressure under the heel of the good leg may decrease. When this pattern of effort is present, it is referred to as a Hoover's sign.
