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… hysteria behaves as though anatomy did not exist . . .
-Freud (*RF reference 1*, p. 169)
Every decade proclaims the death of hysteria, but simulated neurologic disorders continue to be common and confusing, if less fashionable than a century ago. Recognizing pseudoneurologic defects is particularly important in the current parsimonious era of medical cost-effectiveness.
Hysterical signs represent the patient's conception of disease modified by suggestions from the examining physician. Diagnosis depends on recognition of the patient's nonanatomic patterns. Hysterical visual field loss, often confusing when tested by automated perimetry,2 can be recognized quickly using simple confrontation techniques. Because spurious field defects rarely coincide with anatomic reality, they are especially helpful in identifying suggestible patients. To delineate the patterns of hysterical hemianopic visual field loss, I analyzed my experienced with patients having spurious visual field defects.
Patients. I reviewed my notes on inpatients with hysterical visual field defects, personally examined on the wards of the Los Angeles County/University of Southern California Medical Center during the past 25 years. Visual field examinations utilized double simultaneous finger-counting confrontation followed by centripetal presentation of moving fingers. Selected patients also were …
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