Wahid Bakhsh Sajid, Farrukh Akhtar.
Malingering a diagnostic dilemma.
Pak Armed Forces Med J Jan ;57(3):239-42.

A 23 years old presented for the evaluation and disposal on account of his resistant and unexplained paralysis of left lower limb of 7 months duration. The history revealed that, the patient fell from stairs while going to the classroom in PMA. He sustained blunt injury to his lower back. A week later while hospitalized he fell from a stretcher as he was being carried to the ward and sustained blunt injury to his lower back. Following this he became paraplegic and lost control of his bowels and bladder. CT mentioned injury to T12 while MRI thoracic spine reported cord contusion. In another hospital, he was subjected to a battery of investigations including MRI lumbar region. The report mentioned left posterior paramedian herniation of nucleus pulposis of L4-5 intervertebral disc. Nerve conduction studies carried out in AFIRM suggested polyneuropathy which was not held so firmly during discussion with the reporter. Subsequently patient started improving during hospitalization. A medical board was held at CMH Rawalpindi for his invalidement out of service with disability class `A`, with attendant allowance. While the board proceedings were in progress, he was reviewed by neurophysician, who referred him to the psychiatrist. The psychiatrist during the interview and examination found that the patient was indifferent towards his disability, was excessively emotional and exhibited attention-seeking behavior. Taking into account history, clinical examination, investigations and psychiatric assessment he was diagnosed as a case of malingering.

PakMediNet -Pakistan's largest Database of Pakistani Medical Journals - http://www.pakmedinet.com