Hoover's sign: Clinical relevance in Neurology

Area of Science:

• Neurology
• Clinical Examination

Background:

• Pyramidal weakness can be organic or functional (psychogenic).
• Differentiating these causes is crucial for accurate diagnosis and treatment.
• Bedside clinical tests are valuable when the nature of hemiparesis is uncertain.

Purpose of the Study:

• To evaluate Hoover's sign as a clinical tool for differentiating organic from functional hemiparesis.
• To assess the diagnostic accuracy of Hoover's sign.

Main Methods:

• Hoover's sign involves assessing hip flexion against resistance in the affected and unaffected limbs.
• The test relies on observing examiner-applied pressure under the patient's heel.
• The sign is elicited during the examination of lower limb weakness.

Main Results:

• Hoover's sign demonstrated moderate sensitivity (63%) and high specificity (100%).
• A positive sign (increased pressure on the affected side) suggests functional weakness.
• A negative sign (no increased pressure) is indicative of organic weakness.

Conclusions:

• Hoover's sign is a valuable bedside test for distinguishing functional from organic hemiparesis.
• The test's high specificity makes it reliable for identifying psychogenic weakness.
• Clinical judgment and awareness of limitations are essential when interpreting Hoover's sign.