Functional Neurological Disease

Signs

Hoover’s Sign

Two parts/types:

Normal power in hip extension in the ‘weak’ limb when the patient is asked to flex the ‘normal’ limb.

- Demonstrates that ‘weak’ leg is able to generate force

Weakness of hip extension in the ‘normal’ contralateral limb when patient is asked to flex the ‘weak’ limb.

- Demonstrates lack of effort

Abductor Sign

(Sonoo, JNNP 2004; 75 121-125)

Elbow Flex-Ex Sign

(Lombardi et al. JNNP 2014 85: 165-167)

BARRE SIGN (MANOEUVRE DE LA JAMBE)

The patient lies in a pronated position, legs flexed (knees

touching the bed): the weak leg stays in position (instead

of slowly falling, as in organic weakness) or instantly

drops without any contraction of the hamstrings

STERNOCLEIDOMASTOID TEST

In a stroke, sternocleidomastoid weakness is relatively

unusual as the innervation is bilateral. However, if there

is weakness then you would expect that to be of head

turning to the contralateral side. In some patients with

functional hemiparesis there is weakness of head turning

to the ipsilateral side (Diukova et al., 2001).

FINGER ABDUCTION

This tests synkinetic (fifth-finger abduction) movement

of the weak hand during abduction of the healthy fingers

(contralateral hand) against resistance (Tinazzi et al.,

2008). This may be useful in patients with complete

paralysis of the hand.