When a patient falls (asleep) and can’t get up: conversion disorder – paraplegia following general anesthesia

Mason, C. LaToya

doi:10.1016/j.bjane.2014.10.002

Cited by 7 publications

(8 citation statements)

References 7 publications

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“…FNSD is prevalent in up to 0.5% of the general population, with a female to male ratio of 2:1 to 10:1 [4,5,[7][8][9]. Its prevalence in the perioperative setting is unknown [5,9].…”

Section: Discussionmentioning

confidence: 99%

“…The review suggested that procedures involving anesthesia were relatively common triggers for the development of FNSD. FNSD has been described after moderate sedation, neuraxial anesthesia, and general anesthesia [5][6][7][8][9][10]. Deficits that have been reported include monoplegia, hemiplegia, paraplegia, quadriplegia, amnesia, aphonia, delayed awakening, blindness, deafness, and seizures.…”

Section: Introductionmentioning

confidence: 99%

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Functional Neurological Symptom Disorder: A Continuing Conundrum for the Perioperative Physician

Chin¹,

Kumaraswami²

2023

Cureus

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Functional neurological symptom disorder (FNSD) or functional neurological disorder (FND) or conversion disorder, is a syndrome of neurological complications unexplained by neuropathology. The term FNSD or FND is now preferred, as conversion disorder is not an etiologically neutral term and is thus falling from use by researchers and clinicians in the field.We report a case of new-onset postoperative neurological deficit in a patient who had undergone uneventful general anesthesia for a urology procedure. Postoperatively, in the post-anesthesia care unit, the patient was found to be unable to move her upper and lower limbs. Organic pathology was excluded and a diagnosis of FNSD was made. Four weeks after the surgery, the patient was only able to ambulate with the help of a mechanical walker device.It is now suggested that procedures involving anesthesia are relatively common triggers for the development of FNSD. The occurrence of FNSD in the postoperative period is increasingly being attributed to the effects of anesthesia, the hypothesis being that it arises from the abreactive or dissociative effects of anesthetic agents. Another theory is the vulnerability of the anesthetized state which may evoke previous traumatic experiences. Psychiatric co-morbidities such as anxiety and depression may be seen in these patients. Preoperative psychological assessment may help identify patients at risk for FNSD. If postoperative neurological deficit occurs, detailed neurological, metabolic, and psychiatric assessments should be done with FNSD being a diagnosis of exclusion. We present this case to increase awareness regarding this uncommon condition which can cause significant distress to the patient and healthcare team. Management should comprise honest disclosure, reassurance of recovery, and reinforcement of alternative coping strategies. The development of preoperative screening tools may help identify patients at risk for this disorder.

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“…FNSD is prevalent in up to 0.5% of the general population, with a female to male ratio of 2:1 to 10:1 [4,5,[7][8][9]. Its prevalence in the perioperative setting is unknown [5,9].…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Functional Neurological Symptom Disorder: A Continuing Conundrum for the Perioperative Physician

Chin¹,

Kumaraswami²

2023

Cureus

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“…[ 10 ] Risk factors for CD include emotional stressors, a personal or family history of psychiatric illness, childhood abuse, or neglect and a history of neurological disease that causes the same symptoms. [ 11 ]…”

Section: Discussionmentioning

confidence: 99%

Conversion disorder upon emergence from general anesthesia—A case report and review of literature

et al. 2021

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Conversion disorder (CD) is a neurological symptom that is not related to any medical or neurological disease. Symptoms can range from sensory complaints to loss of consciousness. Psychological stressors such as surgery and anesthesia are considered a precipitating factors. Early diagnosis is crucial to prevent unnecessary interventions. Here, we report a case of a patient who developed CD upon emergence from general anesthesia.

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“…There are several case reports of conversion disorder presenting during the postoperative period with symptoms like paraplegia, headache, visual loss, non-epileptic seizures and hyperventilation. [3][4][5][6][7] But these patients had risk factors and occurrence of such events in the past.…”

Section: Discussionmentioning

confidence: 99%

A Case of Hyperventilation leading to apnea and desaturation in PACU

Thapa

Subedi

Poudel

et al. 2019

Preprint

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Background: Respiratory adverse events are not uncommon in the post anesthesia care unit (PACU) following general anesthesia. In this regard, hyperventilation leading to apnea and desaturation is a rare entity. Here we have reported a case of a 15-year-old girl who, following an uneventful general anesthesia, developed severe hyperventilation leading to apnea and desaturation in the PACU. Case presentation: The 15-year-old girl underwent cortical mastoidectomy under general anesthesia. After a smooth anesthesia and an uneventful early recovery, she developed hyperventilation after about 15 minutes in the PACU. The symptom was severe enough to lead to apnea, desaturation and severe respiratory alkalosis. She required bag and mask ventilation and the symptoms resolved only transiently with propofol sedation. Finally she responded to intravenous haloperidol and did not have any further episode after receiving haloperidol Conclusion: Hyperventilation after a smooth recovery from anesthesia is not a common presentation. In this article we have tried to discuss the possible cause of such symptom in our patient and how we successfully managed this case. We have also proposed an algorithmic approach to diagnose and manage such a case in the PACU.

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When a patient falls (asleep) and can’t get up: conversion disorder – paraplegia following general anesthesia

Cited by 7 publications

References 7 publications

Functional Neurological Symptom Disorder: A Continuing Conundrum for the Perioperative Physician

Functional Neurological Symptom Disorder: A Continuing Conundrum for the Perioperative Physician

Conversion disorder upon emergence from general anesthesia—A case report and review of literature

A Case of Hyperventilation leading to apnea and desaturation in PACU

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