The case presentation was directed toward demonstrating how difficult it can be to establish a diagnosis of a neurological disease before there is a signature sign and how illness-related behavior, and interpretations of secondary gain, may sadly confound the clinician. It is helpful that a CSF assay for the 14-3-3 protein is now available, making a diagnosis of Creutzfeld-Jacob disease more straightforward in patients with otherwise ambiguous symptoms. In the case presented, there were no T2-weighted hyperintensities in the basal ganglia or elsewhere on the MRI of the patient’s head. Furthermore, at that time, diffusion-weighted scans were not available, although they appear to be a relatively sensitive marker for Creutzfeld-Jacob disease (1). Fortunately, other individuals with conversion disorder whom we have seen on our unit had an illness that was far clearer in presentation and responded to treatment.