Hysterical conversion reactions mimicking neurological disease
I. H. Bangash, G. Worley and R. S. Kandt
Department of Pediatrics, Duke University Medical Center, Durham, NC.
Seven children with illnesses diagnosed as hysterical conversion reactions
(HCRs) were treated at our institution over a period of nine months. They
all had neurological symptoms that included one or more of the following:
paralysis, headache, seizures, and episodic blindness. All patients but one
were misdiagnosed as having an organic disease prior to our final
diagnosis. Five children were treated with medications for presumed organic
illnesses. In all of these children a diagnosis of HCR was made on the
basis of their history and neurological examination findings. They all
recovered or began recovery within a few days of having HCR diagnosed, and
none of them had had a relapse three to 11 months after the diagnosis of
HCR was made. We believe, and there is ample evidence in the literature,
that a positive diagnosis of HCR in childhood can be made when neurological
manifestations cannot be explained on an anatomic and physiological basis.
Although absence of an obvious organic cause is a helpful clue, exhaustive
exclusion of all possible organic causes is not necessary for the diagnosis
of HCR.
