Margreiter I, Ludin H P
Klinik für Neurologie, Kantonsspital St. Gallen.
Schweiz Med Wochenschr. 1993 Aug 28;123(34):1591-7.
In eight patients psychogenic para- or quadriparesis was clinically diagnosed. The following features were identified as positive criteria for psychogenic etiology: (1.) contradictory clinical findings (normal muscle tone, normal reflexes, no pyramidal signs, alternating muscle power at varying situations of clinical examination etc.), (2.) paradoxical behavior ("belle indifférence"), (3.) normal electrophysiologic, neuroradiologic and cerebrospinal fluid findings. Overemphasizing technical versus clinical diagnosis involves the risk of expensive diagnostic and therapeutic procedures and favors fixation on the symptoms.
八名患者经临床诊断为心因性轻瘫或四肢瘫。以下特征被确定为心因性病因的阳性标准:(1)矛盾的临床发现(肌张力正常、反射正常、无锥体束征、在不同临床检查情况下肌肉力量交替等),(2)矛盾行为(“满不在乎”),(3)正常的电生理、神经放射学和脑脊液检查结果。过度强调技术诊断而非临床诊断存在进行昂贵诊断和治疗程序的风险,且倾向于执着于症状。