A 22-year-old woman develops sudden inability to move her left leg following a stressful event. MRI brain and spine are normal. Neurological examination shows Hoover's sign. What is the most appropriate initial management approach?

• A Reassure that imaging is normal and discharge
• B Start high-dose steroids for presumed demyelinating disease
• C Explain the diagnosis as a Functional Neurological Symptom Disorder and refer for physiotherapy and CBT ✓
• D Prescribe SSRIs and advise complete bed rest

Explanation

This is Functional Neurological Symptom Disorder (Conversion Disorder). Hoover's sign — involuntary hip extension during voluntary hip flexion of the contralateral limb — is a positive physical sign confirming functional weakness. The current evidence-based approach (per UK NICE, AAN guidelines) is to give the patient a clear, non-dismissive positive diagnosis (not 'nothing is wrong'), explain the mechanism (brain cannot access normal movement), and refer for specialized physiotherapy (for motor FND) and CBT. Simple reassurance without explanation leads to poor adherence. SSRIs have limited evidence. Steroids are inappropriate without a demyelinating diagnosis.

Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.