Functional limb weakness — SCE Neurology MCQ

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HardFunctional, Rehabilitation and DVLAFunctional limb weaknessSCE Neurology

A patient has sudden leg weakness after a panic episode. Hip-extension strength normalises when the opposite hip is flexed against resistance, reflexes are normal and imaging excludes a relevant structural lesion. How should the diagnosis be communicated?

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Correct answer: B — Mechanism-based FND explanation with motor-retraining rehabilitation

The best answer is “Mechanism-based FND explanation with motor-retraining rehabilitation”. Hoover’s sign is a positive inconsistency demonstrating preserved automatic motor capacity; clear non-judgemental explanation and goal-directed FND physiotherapy are part of treatment. “Say that normal imaging proves the symptoms are imagined” is less appropriate because functional symptoms are genuine and diagnosis rests on positive signs rather than disbelief “Withhold a diagnosis until every conceivable neurological test is normal” is less appropriate because indiscriminate exclusion testing reinforces uncertainty and is not required after appropriate assessment “Present the weakness as malingering because strength varies during examination” is less appropriate because variability is a diagnostic feature of altered motor control rather than proof of intentional deception “Recommend unsupervised strengthening without explaining the diagnosis” is less appropriate because rehabilitation works best when linked to a shared mechanism-based explanation

Reference: Physiotherapy for functional motor disorders: consensus recommendation. https://pmc.ncbi.nlm.nih.gov/articles/PMC4602268/ NICE NG127: Suspected neurological conditions — recommendations. https://www.nice.org.uk/guidance/ng127/chapter/Recommendations