A 22-year-old woman is admitted to the hospital because of right-hand anaesthesia, that developed after an argument with her brother. She is in good spirits and seems unconcerned about her problem. There is no history of physical trauma. The neurologic examination is negative EXCEPT for reduced sensitivity to pain in a glove-like distribution over the right hand. Her entire family is in attendance and is expressing great concern and attentiveness. She ignores her brother and seems unaware of the chronic jealousy and rivalry described by her family. The most likely diagnosis is
A 22-year-old woman is admitted to the hospital because of right-hand anaesthesia, that developed after an argument with her brother. She is in good spirits and seems unconcerned about her problem. There is no history of physical trauma. The neurologic examination is negative EXCEPT for reduced sensitivity to pain in a glove-like distribution over the right hand. Her entire family is in attendance and is expressing great concern and attentiveness. She ignores her brother and seems unaware of the chronic jealousy and rivalry described by her family. The most likely diagnosis is
💡 Explanation
**Core Concept**
The patient's symptoms of glove-like anesthesia in the right hand, lack of concern, and family history of jealousy and rivalry suggest a conversion disorder, a type of functional neurological symptom disorder (FNSD) characterized by the involuntary production of neurological symptoms that cannot be explained by a medical condition.
**Why the Correct Answer is Right**
Conversion disorder is a psychological disorder where unconscious conflicts or stress manifest as physical symptoms, such as numbness or paralysis. In this case, the patient's glove-like anesthesia may be a result of her unconscious conflict with her brother, as evidenced by her ignoring him and seeming unaware of his emotions. This phenomenon is often referred to as "la belle indifférence," where patients show a lack of concern or emotional response to their symptoms.
**Why Each Wrong Option is Incorrect**
**Option A:** Stroke or transient ischemic attack (TIA) can cause numbness or paralysis, but it is unlikely given the patient's good spirits and lack of concern, as well as the absence of any physical trauma or history of vascular disease.
**Option B:** Hypoglycemia can cause numbness or tingling, but it is unlikely given the patient's normal behavior and absence of other symptoms such as confusion, sweating, or tremors.
**Option C:** Peripheral neuropathy can cause numbness or tingling, but it is unlikely given the patient's glove-like distribution of symptoms and lack of other symptoms such as weakness or pain.
**Clinical Pearl / High-Yield Fact**
Conversion disorder is a common cause of neurological symptoms in young adults, and it is often associated with unconscious conflicts or stress. The key to diagnosis is the presence of "la belle indifférence," where patients show a lack of concern or emotional response to their symptoms.
**Correct Answer: C. Peripheral neuropathy**
✓ Correct Answer: D. Conversion disorder
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