The Soto Saline Sign for Pseudoseizures

​Conversion reactions are commonly seen conditions in health care and come in various forms and presentations. Two common conversion reactions seen in the emergency department are conversion coma and psychogenic nonepileptic seizures (PNES). Both mimic life-threatening conditions and require rapid differentiation. Premature anchoring and wrong diagnoses can result in potentially harmful outcomes or expensive and unnecessary procedures, workups, and evaluations.​Conversion disorder, or functional neurological symptom disorder, is categorized under the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, (DSM-5) under the category of "Somatic Symptom and Related Disorders." Conversion disorder is characterized by physical symptoms or deficits affecting voluntary motor or sensory function that resemble those of a nervous system disorder. Common examples of conversion symptoms are blindness, diplopia, paralysis, amnesia, coma, aphonia, seizures, pseudocyesis, and others. These physical signs and symptoms are typically triggered by emotional or mental factors such as conflict or other stressors. Unlike factitious disorders and malingering, the symptoms of somatoform disorders are not intentional or under the patient's conscious control.Psychogenic Nonepileptic Seizures (PNES)Patients presenting with PNES may show symptoms that look similar to those of epileptic seizures. They can mimic absence seizures, complex partial seizures, or tonic-clonic seizure...
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