Conversion hysteria: a neurologic emergency.
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A social pediatric emergency invokes the concept of a crisis situation, which often reflects an acute temporary state, the culmination of problems of long duration. The needs demonstrated in child abuse, neglect and deprivation, sexual abuse, the handling of the crisis of birth, pregnancy and abnormality, death and dying, adoption and learning disabilities are related to the family psychodynamic relationships and the doctor team approach. The social pediatrician can play his role as the physician, advocate, activist and educationalist in the many complex situations revealed within family, community and society.
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Aspects of geography are important in relation to the establishment of body ego, since they inevitably supply from the external world the early symbols that represent in the mind the basic elements of infantile experience in regard to body parts, functions, and relationships with primal objects. The accretional inter-twining of all subsequent psychic conflicts can therefore be expressed in symbolic geographic terms. These conflicts center on the developmentally evolving meanings of the mother's body as epitomized in the riddle of the Sphinx. Illustration of the concepts includes a brief clinical report and selected literary and mythological examples.
Child abuse is common in most, if not all, Western nations; it probably occurs worldwide. It may be a major factor in the increase in violence throughout much of the world. Radiologists who treat children should think of the possibility of abuse whenever they diagnose a fracture, intracranial bleed, or visceral injury, especially when the history is not compatible with their findings. Metaphyseal "corner" fractures in infants usually are caused by abuse. Less than 20% of abused children, however, present injuries that can be recognized by radiologic techniques. Consequently normal roentgenograms, nuclear medicine scans, ultrasound studies, and computed tomograms do not exclude child abuse.
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