Doctor presents for a 3 rd neurological opinion regarding recurrent blackouts preceded by a gustatory aura . Past history of unexplained haematemesis. Exam, EEG, and CT scan normal. No response to anticonvulsant Rx.
Admitted to hospital. EEG normal during “fit”. Observed attacks are not epileptic. Other records emerge and disclose repeated admission to other hospitals for fits and status epilepticus. Multiple tests and lumbar punctures normal. On one occasion ended up in ICU where he sustained a pneumothorax from interventions.
Blood from emesis “not human, possibly bovine”
Presents rifle (unloaded) and threatens to kill me.
Suspended by Medical Council. Suicide years later.
Blue collar worker repeatedly admitted obtunded or comatose to hospital.
Usually found stuporous or unconscious sitting in front of TV. Scans and lumbar punctures normal. Neurological exam normal. Referred with Dx “Recurrent idiopathic coma”.
Simple amiable man. Wife is a switched on accountant and calls soon after another episode. Finds “ white powder ” at bottom of his tea cup next to TV. Analysis: benzodiazepine, which is also found in his hospital toxicology screen
Wife locates lorazepam tabs in daughter’s belongings. Girl has rheumatoid arthritis and attends doctors frequently.
Family all agree to go to psychiatrist but outcome of exercise is “sensitive and confidential”
Neurologica Diabolica Is Part Of Which Syndrome? Who first described it?
Asher selected "Munchausen's syndrome" because of the similarity between the wanderings and fabrications of these patients and the travels and fantastic anecdotes attributed to Baron von Munchausen (1720-1797). But here the similarity ends, for the Baron never submitted himself to medical operations and procedures as these patients do.
Who was Munchausen? Doppelgängers: one real and one mythical
The authentic Baron Freiherr Karl Friedrich Hieronymus von Münchhausen (note correct spelling) was a German veteran of the Russian wars against the Turks.
He was well-known in European social circles for his entertaining accounts of his military exploits, and was said to be prone to exaggeration.
A series of such droll tales were published in the German periodical from 1781 to 1783.
Vade Mecum für lustige Leute
Wunderbare Reisen zu Wasser und Lande, Feldzuge und lustige Abentheuer . . . des Freyherrn von Munchhausen-aus dem Englischen ... ubersetzt.
much to the embarrassment of the Baron
Who was the mythical Munchausen? The Adventures of Baron Munchausen , one of the most famous books of tall tales, is attributed to Rudolf Erich Raspe, who in 1787 produced an affidavit supporting veracity of his tales, purportedly signed by Lemuel Gulliver, Sinbad the Sailor, Aladdin, and the Lord Mayor of London,
Download X-Rays and scans from Google Science and present them as their films
Join specialised internet groups and appropriate their ailments. With the exponential increase in the number of people with internet access, "virtual" support groups have multiplied. Many of them, conducted by e-mail or internet postings and sometimes requiring a subscription, have been established for persons with particular diseases. (ie “fibromyalgia, chronic fatigue syndrome, some cancers)
Feigned HIV, in which people mimic infection with or disease due to HIV, accounted for 1.7% of admissions to a specialist HIV unit in Central London over a 5 year period. 12 patients feigned HIV/AIDS, 11 were HIV antibody-negative, and one refused testing.
Presenting histories were sometimes grandiose, unusually tragic, or unlikely in relation to the patients' healthy appearance, and often included admissions to other specialist HIV units. Substance abuse was suspected in over half of the patients described, a higher frequency than that observed in our HIV-infected patient population
Veterinary Munchausen “ Shouldn’t he be lying at the foot of the bed?” “ Here he is again. Poor Fido.”
Differential diagnosis (1) Authentic physical disorder (2) Malingering: conscious, volitional, situationally appropriate behaviour aimed toward clear secondary gain (3) Somatoform: (aka hysteria) nonorganic illness in which the signs and symptoms are non-volitionally simulated and secondary to unconscious drives and for which there is no apparent secondary gain
Plagiarised from classical Munchausen and adapted to apply to someone else (usually children) who presented with a false illness or story invented caused by someone else (a proxy). First described by Meadow ( whom we shall hear more about soon ) in 1977.
Illness in a child which is fabricated by a
parent, or someone who is in loco parentis.
The child is presented for medical assessment and care, usually persistently, often resulting in multiple medical procedures.
The perpetrator denies the aetiology of the child's illness.
Acute symptoms and signs of illness cease when the child is separated from the perpetrator (or victim dies)
false history and repetitive poisoning (hypoglycaemics, anticoagulants, sedatives, salt solutions)
Proxies are usually but not exclusively mothers (Mommy Munchausen). May act when unobserved in hospital. Trapped by video surveillance or less convincingly by deductive reasoning. If the premises are true the conclusion must also be. ie 3 of Mrs Smith’s children have died unexpectedly. This cannot be by chance or known disease, so maybe they died of unnatural causes.
Problematic term, as victim is innocent and motivations of proxy may vary from mildy mischievous to murderous ie :
(1)Transfer of proxy’s emotional “needs” to the victim( “true” Munchausen by proxy)
(3) Criminal: resulting in death or maiming.
Of note Mommy Munchausens are regarded by legal system as “crying for help” and until recently usually escaped jail. Daddy Munchausens usually jailed. Often more than one victim in the family. Coexisting vet Munchausen common.
Professor Sir Roy Meadow endorsed the dictum that “one sudden infant death is a tragedy, two is suspicious and three is murder, until proved otherwise.
testified that the odds against two cot deaths occurring in the same family was 73,000,000:1. Wrong. The Royal Statistical Society issued a press release stating that the figure had "no statistical basis" Estimates are mostly in the region of 1:100.
Meadow struck off but eventually managed to have decision reversed but not before he was discredited.