Munchausen's disorder: a case of a factitious neurological emergency.

Few signs are more ominous than the dilated pupil which is unreactive to light. The deliberate use of this fact and the simulation of other neurologic signs to enhance the aura of a serious illness will often expose a patient to hazardous procedures. A patient with Munchausen's Disorder who made unsuccessful attempts to simulate a neurological emergency is presented. A thorough knowledge of the pathophysiology of neurologic disease will enable the physician to detect the possibility of malingering when confronted with this problem. A strong cholinergic solution will produce pupillary constriction in normals and neurologic disorders but often will not alter the pupil in cases of pharmacologic pupillary paralysis.