Ingrid Hoeritzauer

• ABN/Patrick Berthoud Research Fellow at University of Edinburgh

Objective Functional neurological disorder (FND) most often presents in women of childbearing age, but little is known about FND during the perinatal period. We aim to describe the existing literature of FND during pregnancy, labour and post-partum. Methods We searched Medline, PsycINFO and Embase using search terms covering FND and the perinatal...

Aims and method Functional neurological disorder (FND) most often presents in women of childbearing age, but little is known about its course and outcomes during pregnancy, labour and postpartum (the perinatal period). We searched MEDLINE, PsycInfo and Embase combining search terms for FND and the perinatal period. We extracted data on patient demo...

Background Functional neurological disorder (FND) is characterised by neurological symptoms, such as seizures and abnormal movements. Despite its significance to patients, the clinical features of chronic pain in people with FND, and of FND in people with chronic pain, have not been comprehensively studied. Methods We systematically reviewed PubMe...

Cauda equina syndrome (CES) is a spinal emergency that can be challenging to identify from among the many patients presenting to EDs with low back and/or radicular leg pain. This article presents a practical guide to the assessment and early management of patients with suspected CES as well as an up-to-date review of the most important studies in t...

Aims: Patients with cauda equina syndrome (CES) require emergency imaging and surgical decompression. The severity and type of symptoms may influence the timing of imaging and surgery, and help predict the patient's prognosis. Categories of CES attempt to group patients for management and prognostication purposes. We aimed in this study to assess...

Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is a disabling long-term condition of unknown cause. The National Institute for Health and Care Excellence (NICE) published a guideline in 2021 that highlighted the seriousness of the condition, but also recommended that graded exercise therapy (GET) should not be used and cognitive–behavi...

Background: Chronic pain is a common comorbidity in those with functional neurological disorder (FND), however the prevalence and characteristics of FND in those with chronic pain is unknown. Methods: A retrospective electronic records review of consecutive new patients attending a chronic pain clinic of a regional service. Clinical features, me...

Functional neurological disorder (FND) is a common and disabling disorder, often misunderstood by clinicians. Although viewed sceptically by some, FND is a diagnosis that can be made accurately, based on positive clinical signs, with clinical features that have remained stable for over 100 years. Despite some progress in the last decade, people wit...

Background Cauda equina syndrome (CES) results from nerve root compression in the lumbosacral spine, usually due to a prolapsed intervertebral disc. Evidence for management of CES is limited by its infrequent occurrence and lack of standardised clinical definitions and outcome measures. Methods This is a prospective multi-centre observational coho...

Background The term ‘brain fog’ is increasingly used colloquially to describe difficulties in the cognitive realm. But what is brain fog? What sort of experiences do people talk about when they talk about brain fog? And, in turn, what might this tell us about potential underlying pathophysiological mechanisms? This study examined first-person descr...

Objectives/Aims Chronic pain is commonly reported as a comorbidity in patients with functional neurological disorder (FND) however the prevalence of FND in those presenting with chronic pain is unknown. We aimed to estimate 1) the prevalence of FND in patients seen at a chronic pain clinic and 2) how patients with chronic pain and comorbid FND diff...

Objectives The term ‘brain fog’ is increasingly used in social and other media. But what is brain fog? What sort of experiences do people talk about when they talk about brain fog? And, in turn, what might this tell us about potential underlying pathophysiological mechanisms? In this study we examined first-person descriptions of brain fog in order...

Introduction Cauda Equina Syndrome (CES) has significant medical, social and legal consequences. Understanding the number of people presenting with CES and their demographic features is essential for planning healthcare services to ensure timely and appropriate management. We aimed to establish the incidence of CES in a single country and stratify...

Background More than 50% of patients presenting with cauda equina syndrome (CES) have normal imaging. These patients require phenotyping to ascertain symptom aetiology and mechanism. Prospective Study Results 198 patients presented with suspected CES over 28 months. 47 were diagnosed with ‘scan-positive’ CES (mean age 48yrs, 43% female). 76 patien...

Clinicians often struggle to successfully share a diagnosis of a functional movement disorder (FMD) with the patient and their family or friends, and patients often report negative and harmful experiences.In this chapter we explore various aspects of communication with respect to FMD. We conclude that many communication barriers arise from the clin...

Suspected cauda equina syndrome is a common presentation in emergency departments, but most patients (≥70%) have no cauda equina compression on imaging. As neurologists become more involved with ‘front door’ neurology, referral rates of patients with these symptoms are increasing. A small proportion of patients without structural pathology have oth...

Introduction Cauda Equina Syndrome (CES) can cause persisting life-changing dysfunction. There is scarce literature regarding the long-term assessment of CES symptoms, and rarer still is the impact of these symptoms on mental wellbeing investigated. This study assessed the long-term patient reported mental wellbeing outcomes of post-operative CES p...

We present a practical overview of functional neurological disorder (FND), its epidemiology, assessment and diagnosis, diagnostic pitfalls, treatment, aetiology and mechanism. We present an update on functional limb weakness, tremor, dystonia and other abnormal movements, dissociative seizures, functional cognitive symptoms and urinary retention, a...

Introduction It has been suggested for over 100 years that patterns of neurological symptoms and signs in functional neurological disorders may be shaped at a neural level by underlying ideas or preconceptions how neurological symptoms present. This study used experimental simulation to probe ideas about seizures in healthy volunteers, with a view...

Objective To describe clinical features relevant to diagnosis, mechanism and aetiology in patients with ‘scan-negative’ cauda equina syndrome (CES). Methods We carried out a prospective study of consecutive patients presenting with the clinical features of CES to a regional neurosurgery centre comprising semi-structured interview and questionnaire...

OBJECTIVE Cauda equina syndrome (CES) is a surgical emergency requiring timely operative intervention to prevent symptom progression. Accurately establishing the incidence of CES is required to inform healthcare service design and delivery, including out-of-hours imaging arrangements. METHODS A systematic literature search of MEDLINE, EMBASE, and...

Background: The clinical symptoms and signs of Cauda equina syndrome (CES) are non specific and poorly predictive of cauda equina compression on MRI. We aimed to establish whether a history of lumbar spine surgery predicts cauda equina compression on MRI in those presenting with suspected CES. Methods: A retrospective electronic record review was u...

Purpose: Cauda equina syndrome (CES) is a spinal emergency with clinical symptoms and signs that have low diagnostic accuracy. National guidelines in the United Kingdom (UK) state that all patients should undergo an MRI prior to referral to specialist spinal units and surgery should be performed at the earliest opportunity. We aimed to evaluate the...

Functional Movement Disorders are common in neurological practice and a source of significant distress and disability. There is consensus that successful explanation which helps the patient feel confident that the diagnosis is correct is an essential platform for further treatment. Many doctors find delivering the diagnosis difficult. In these two...

Objectives/Aims Foreign accent syndrome (FAS) is a disorder of speech in which listeners perceive the affected individual as speaking with a foreign or different regional accent that is not their habitual accent. FAS is widely understood as an unusual consequence of stroke or other lesions within speech-motor networks. However, case reports of FAS...

Ingrid Hoeritzauer is a neurologist who also has a degree in psychology. She works with the Functional Research Team led by Jon Stone and Alan Carson in Edinburgh and received an ABN/Patrick Berthoud Clinical Research Training Fellowship. Her research interests are observational studies in functional neurological disorders and cauda equina syndrome...

Objectives: We assessed the documentation rates of signs and symptoms, including sexual function, in patients with suspected cauda equina syndrome and whether they can be improved by increasing local awareness. Patients and methods: We reviewed all electronic records of patients referred with suspected CES who required urgent MRI to our regional...

Objective Foreign accent syndrome (FAS) is widely understood as an unusual consequence of structural neurological damage, but may sometimes represent a functional neurological disorder. This observational study aimed to assess the prevalence and utility of positive features of functional FAS in a large group of individuals reporting FAS. Methods P...

Objective: Diagnostic screening for functional neurological disorders (FNDs) continues to pose a challenge. Simple symptom counts fail clearly to discriminate patients with FND but there is increasing recognition of 'positive' features which are useful diagnostically during face-to-face assessments. A self-completed questionnaire evaluating specif...

Background The majority of patients presenting with suspected clinical cauda equina syndrome (CES) have no identifiable structural cause for their symptoms (‘scan-negative’ CES). Understanding these patients aids clinical differentiation and management in CES. Methods A retrospective electronic note review was undertaken of patients presenting wit...

Introduction Cauda equina syndrome (CES) is a potentially devastating condition caused by compression of the cauda equina nerve roots. This can result in bowel, bladder and sexual dysfunction plus lower limb weakness, numbness and pain. CES occurs infrequently, but has serious potential morbidity and medicolegal consequences. This study aims to ide...

There have been many articles highlighting differences and similarities between complex regional pain syndrome (CRPS) and functional neurological disorders (FND) but until now the discussions have often been adversarial with an erroneous focus on malingering and a view of FND as ‘all in the mind’. However, understanding of the nature, frequency and...

Objective In their 1973 BMJ paper ‘Cryptogenic Drop Attacks’, Stevens and Matthews described 40, mostly middle-aged, female patients with drop attacks of unknown cause. Although clinically common, there has been little on this topic since. We aimed to determine clinical features, comorbidity and outcome of patients with drop attacks. Methods We ca...

Background Studies have shown that around half of patients presenting with cauda equina syndrome (CES) have normal imaging, many of whom may have evidence of a functional neurological disorder. Results and Projects to Date The Back or Leg Pain with Bladder symptoms study (BLB) study is a prospective case control study of all patients admitted with...

Introduction: Symptoms and signs of functional (psychogenic) motor and sensory disorder are often said to be dependent on the patients' idea of what symptoms should be, rather than anatomy and physiology. This hypothesis has however rarely been tested. Materials and methods: Inspired by a brief experiment carried out in 1919 by neurologist Arthur H...

Background Drop attacks are idiopathic falls occurring predominantly in middle aged women without warning, not due to change in posture or head movement associated with immediate recovery. Drop attacks have been attributed to cardiovascular, structural, musculoskeletal, epileptic, vestibular and (very rarely) functional/ psychogenic causes. Method...

Background Studies from our group have shown that around half of patients presenting with cauda equina syndrome (CES) have normal imaging, many of whom may have evidence of a functional neurological disorder. We have also shown high rates of comorbidity of functional neurological disorders in patients with idiopathic chronic urinary retention (incl...

Functional, often called psychogenic, disorders are common in neurological practice. We illustrate clinical issues and highlight some recent research findings using six case studies of functional neurological disorders. We discuss dizziness as a functional disorder, describing the relatively new consensus term Persistent Posturo-Perceptual Dizzines...

Functional neurological disorders are common problems in neurologic practice. In the past decade there has been an increasing interest in this group of disorders both from a clinical as well as research point of view. In this review, we highlight some of the most salient and exciting publications from recent years focusing especially on new finding...

AimsTo study the frequency of pain, psychological, or functional disorders in patients with Fowler's syndrome.Methods We carried out a retrospective chart review of patients with a diagnosis of Fowler's syndrome attending the Uro-Neurology centre at the National Hospital for Neurology and Neurosurgery between 2009 and 2013 looking at triggering eve...

In the first prospective comparison of 'scan-negative' (n = 11) and 'scan-positive' (n = 7) patients with cauda equina syndrome (CES) we found that Hoover's sign of functional leg weakness but not routine clinical features differentiated the two groups (p < 0.02). This offers a new direction of study in this area, although magnetic resonance imagin...

Objective: An important but neglected consequence of the AIDS pandemic that continues across sub-Saharan Africa is the phenomenon of child-headed households (CHH). This study aims to describe the challenges to health and well-being for young people living in child-headed households. Methods: A mixed-methods research approach linked common themes...

Camptocormia can be a manifestation of a variety of neurological disorders. Underlying aetiology can often remain elusive. An 81 year old man with previous polio presented with recurrent falls and a 30 year history of progressive difficulty standing straight. On examination, he had camptocormia, facial weakness, subtle fatigable ptosis, proximal li...

Patients with symptomatic aortic valve disease who are inoperable or have high surgery-related risks may be treated with transcatheter aortic valve implantation devices. With this method increasingly applied, device innovations are aimed at achieving improved procedural results and therapeutic outcome. This paper describes the innovations implement...