SHM Converge Scientific Abstract ePoster Gallery-Hoover the Legs to "Clean Out" a Conversion Disorder Diagnosis

Pdf Summary

A 20-year-old man presented to the ED with sudden right leg weakness and low back pain. Because he had a normal initial workup and lumbar MRI showed only mild degenerative changes, the weakness was initially thought to be conversion disorder. However, a more detailed neurologic exam on admission found complete right leg paralysis, a sensory level below the umbilicus, and hyperesthesia below both knees.<br /><br />The hospitalist performed the Hoover sign: when the patient tried to lift one leg, normal involuntary extension force should be felt in the opposite heel. In this case, the findings suggested an organic neurologic problem rather than a purely psychogenic one. The sensory level also pointed to spinal cord pathology above the lumbar spine. This changed the differential diagnosis to conditions such as transverse myelitis, neuromyelitis optica, multiple sclerosis, and other demyelinating disorders.<br /><br />A thoracic spine MRI revealed focal cord abnormalities at T11, and lumbar puncture showed elevated protein and white blood cells, supporting an inflammatory spinal cord process. He was treated empirically with pulse steroids and improved somewhat, then was discharged with outpatient physical therapy and neurology follow-up.<br /><br />The case highlights the value of careful neurologic examination when functional symptoms are suspected. The Hoover sign, first described by Charles Hoover in 1908, is a useful bedside test with very high specificity for functional weakness, but it does not distinguish conversion disorder from malingering and may be affected by pain or mixed organic and functional disease. A sensory level remains an important clue to spinal cord disease and helps guide appropriate imaging and diagnosis.

Asset Subtitle

Jasdave S. Maan

Meta Tag

Author List Jasdave S. Maan, Mohammed Elhassan

Category Clinical Vignettes

Concept Functional Neurologic Disorder

Concept Hoover Sign

Concept Weakness

Concept Organic Neurologic Disease

Concept Sensory Level

Distinguished Non-Finalist

Presenter Organization St Agnes Medical Center

Presenting Author Jasdave S. Maan

Track Adult

Keywords

Hoover sign

functional weakness

conversion disorder

spinal cord pathology

sensory level

transverse myelitis

neuromyelitis optica

multiple sclerosis

thoracic spine MRI

inflammatory myelopathy

Functional Neurologic Disorder

Hoover Sign

Weakness

Organic Neurologic Disease

Sensory Level