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Malignant Stroke
January 2000

Q. Are there web sites that contain information relative to the incidence of people faking strokes and attributing the causes to events immediately prior or more distantly removed in time? I know a school counselor who has a mild case of MS and is grieving the district for causing him stress on the job (which he has not performed as specified from day one).

Having been given a letter reducing his employment to half time for failure to do all that the job entails. He will attend a school football game in perfect demeanor, but the next day have a "stroke" which hospitalizes him for a week or two for tests and observation. He manages to secure letters from doctors attesting to his stress-related condition (e.g., unable to teach in a classroom because he can't process information quickly - i.e., he can't maintain control of a class of 20), and even has a doctor submit a letter from 700 miles away (the Dr. treated him for MS 2-4 years ago and is retired as of 1998) saying that a letter such as he received could well trigger a stroke.

Back to my original query: are strokes always genuine? How is their genuineness testable?

A. Unfortunately in today's complex, often stressful and litigious world, exaggerating and or faking an illness for secondary gain is not rare (often termed "malingering"). The case you inquired about is quite complex because this individual has had a diagnosis of MS (Multiple Sclerosis). This is a disorder of the brain and spinal cord that can cause virtually any neurologic symptom/abnormality.

On top of this, he has reportedly had some strokes (injury to the brain due to inadequate circulation to that area of the brain). Both MS and strokes usually show an abnormality on head MRI scan. MS may also show abnormalities on spinal tap. There also should be objective abnormalities found on physical exam. It would be pretty hard to successfully fake MS or stroke in the hands of a good neurologist. However, I'm sure some have tried!

There is a psychological disorder termed somatization or conversion disorder, in which we believe that severe psychologic stress can result in various physical symptoms including weakness or numbness of the body which can mimic a stroke. However, on diagnostic testing such as head MRI, the results are normal. Sometimes neuropsychiatric testing can be helpful to distinguish mental from physical disorders.

I hope some of this is helpful to you and wish you well in dealing with this difficult scenario. See Ref.

Ref: http://www.medleague.com/Detecting_Malingering.htm

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