•Conversion Disorder/Functional Neurological Disorder/Functional Neurological Symptom Disorder (FNSD) is recognized in the DSM-5 is defined as a mental disorder characterized by neurologic symptoms (either motor or sensory) that are incompatible with any known neurologic disease1.

•Common Symptoms include weakness and/or paralysis, non-epileptic seizures, movement disorders, speech or visual impairment, difficulty swallowing, sensory disturbances, or cognitive symptoms.

•Incidence is estimated to be 4-12/100,000 individuals annually.

•Usual presents in middle age between 35-50 years old.

•Risk factors include pre-existing neurologic disorder (e.g., epilepsy, migraines, movement disorders), recent trauma or stress, mental health condition, family history, and physical and/or sexual abuse history.

•Reported to occur in woman more than men.

•37% of individuals with conversion disorder have had a physical injury preceding symptom onset2,3. It often occurs suddenly after a stressful event.

•It is important to remember that no conscious effort on part of the patient for their symptomatology (i.e., it is must be distinguished from malingering or factitious disorder.

•Differential diagnosis includes factitious disorder, malingering, an unrecognized mental disorder, neurologic disease, somatic symptom disorder, dissociative disorders, and panic disorder.

•Patient is a 25-year-old male who presented for outpatient surgery for removal/examination of an anal skin tag.

•Patient is multilingual and speaks six languages, including fluent English. He explicitly requested a Spanish or French interpreter in the post-operative period.

•Procedure was uncomplicated and went as planned performed under Monitored Anesthesia Care with propofol sedation with a natural airway.

•In the immediate post-operative period, patient developed hyperactive delirium with glazed look in eyes and hyperactive movement in extremities in Post Anesthesia Care Unit which necessitated sedation with 24mcg of dexmedetomidine.

•Patient began speaking only non-English languages and was unable to communicate with the interpreters, expressing confusion.

•After two hours, patient’s mental status improved and was orientable, however he reported inability to move his bilateral lower extremities. He reported feeling as if they were “asleep.” Patient had in-tact sensation but apparent paralysis.

•Laboratory assessment, including venous blood gas, complete blood count, coagulation studies, and basic metabolic panel were obtained and within normal limits.

•Neurology was consulted and interviewed the patient in English. Patient had a normal neurologic exam in which they did not find any focal neurologic deficits to suspect an organic cause. Patient did have tremulousness in lower extremities without drift, but full strength with individual muscle group testing. Neurology determined that the patient’s symptoms were due to Conversion Disorder/Functional Neurologic Symptom Disorder in the setting of perioperative stress.

•Patient had continued monitoring in PACU with complete recovery at 3.5 hours. He was discharged home with return precautions and scheduled follow up at 5 weeks.

•At 5 week follow up, patient reported no ongoing symptomatology nor sequelae.

 

 

 

Conclusions

 

 

References