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throughout the entire 9 months, and occasionally pregnancy will be interrupted because of it Anorexia may be a prominent associated symptom and must be differentiated from anorexia nervosa bulimia, another closely related disease of young women (page 1304) Hysterical Seizures, Trances, and Fugues These conditions seem to be less frequent than in the days of Charcot, when la grande attaque d hysterie was often exhibited before medical audiences Nevertheless, such attacks do occur and must be distinguished from cerebral cortical seizures and catalepsy To witness an attack is of great assistance in diagnosis The lack of an aura, initiating cry, hurtful fall, or incontinence; the presence of peculiar movements such as grimacing, squirming, thrashing and ailing of the limbs, side-to-side motions of the head, and striking at or resisting those who offer assistance; the retention of consciousness during a motor seizure that involves both sides of the body; the long duration of the seizure, its abrupt termination by strong sensory stimulation, lack of postictal confusion, and failure to produce a rise in creatine kinase are all typical of the hysterical attack Sometimes hyperventilation will initiate an attack and is therefore a useful diagnostic maneuver Both epilepsy, particularly of frontallobe type, and hysteria may occur in the same patient, a combination that invariably causes dif culty in diagnosis Hysterical trances or fugues, in which the patient wanders about for hours or days and carries out complex acts, may simulate temporal lobe epilepsy or any of the conditions that lead to confusional psychosis or stupor Here the most reliable point of differentiation comes from observation of the patient, who, if hysterical, is likely to indicate a degree of alertness and promptness of response not seen in temporal lobe seizures or confusional states Following the episode, an interview with the patient under the in uence of hypnosis, strong suggestion, or midazolam or amobarbital will often reveal memories of what happened during the episode This helps to exclude the possibility of an epileptic spell Hysterical Paralyses, Gait, Sensory Loss, and Tremors Hysterical palsies may involve an arm, a leg, one side of the body, or both legs If the affected limb can be moved at all, muscle action is weak and tremulous Movements are slow, tentative, and poorly sustained; often it can be demonstrated that the strength of voluntary movement is proportional to the resistance offered by the examiner, thus imparting a give-way character (page 52) One can detect by palpation that agonist and antagonist muscles are contracting simultaneously holding the limb in place rather than opposing the examiner, and when the resistance is suddenly withdrawn, there is no follow-through or rebound, as is normally the case Other indicators have been devised to demonstrate inconsistencies with normal physiologic principles and a purposive lack of cooperation These are elaborated in articles by Stone, Zeman, and Sharpe The discrepancies are usually found by testing an agonist, antagonist, or xator movement while the patient is focused on making an effort with another group of muscles (eg, the Hoover sign, see page 52) Muscular tone in the affected limbs is usually normal, but slight resistance may sometimes be found A seeming lack of effort and the absence of full compliance with the examiner s requests during the testing of muscle strength, while common in hysterical patients, is not con ned to them; one encounters such ndings not infrequently during the examination of suggestible but nonhysterical patients who harbor a neurologic disease Walking and standing may be impossible (astasia-abasia) or.

The symptom of speaker static might be the result of a number of problems, but it is very unlikely to be caused by the sound card First, check the volume on the speakers and the software If the speakers are turned way up but the computer s software-controlled volume is turned down or off, the speakers transmit the only signals they are receiving static The static could also be the result of a failing cable Replace the cables with known good ones If the static persists, it could be due to EMI (electromagnetic interference) Move the speakers as far away from desktop lights, the monitor, and other interference-causing devices as you can To rule out the speakers and cables, replace them with known working ones The static could also be the result of bad data in the sound file Try to play a different sound file to see if the static continues Similarly, if you are listening to a CD, try another CD

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