A conversion disorder or a stroke? A proximal basilar artery thrombosis induced ‘locked-in’ syndrome in a young Caucasian woman

Abstract

SUMMARYThe incidence of the basilar artery occlusion is relatively low among all strokes. Clinical presentation varies depending on the location of the occlusion. The symptoms include mild dysarthria to coma or sudden death. The initial subtle clinical presentation could lead to misdiagnosis. Psychogenic diagnosis in the differential could make the timely diagnosis more difficult. This case involves a 34-year-old woman presenting with a gradual onset of slurred speech. The initial CT scan of head did not indicate any intracranial pathology, and she was initially treated for an anxiety/conversion disorder. With progression of the pathology, the patient quickly developed a 'locked-in' syndrome, with preserved high cognitive function and vertical eye movement, but otherwise total loss of motor function. The diagnosis was confirmed with MRI/MR angiography studies, which indicated thrombosis of the proximal basilar artery. Serological studies did not disclose any relevant risk factors. BACKGROUND

Patients with Acute Stroke Presenting Like Conversion Disorder

“…The literature reveals many instances of central nervous system pathologies which can easily be confused with conversion disorder. 1,6 If EMTs and emergency physicians approach the situation as conversion disorder hastily and overlook underlying pathology, it could lead serious mortality and morbidity. Surely, evaluation made by inexperienced health professional also has a part in these consequences.…”

“…Conversion disorders are encountered commonly in emergency departments (EDs) in developing countries, including Turkey. However, up to one-half of patients who had been initially diagnosed with conversion disorder were eventually shown to have an underlying organic pathology–mostly neurological or non-psychiatric conditions 1 …”

“…Acute stroke and conversion disorders are commonly confused with each other in the ED setting 1 . Medical literature reveals that possible intracranial pathologies can be overlooked and misdiagnosed as conversion disorder 2 …”

“…However, up to one-half of patients who had been initially diagnosed with conversion disorder were eventually shown to have an underlying organic pathology-mostly neurological or non-psychiatric conditions. 1 Acute stroke and conversion disorders are commonly confused with each other in the ED setting. 1 Medical literature reveals that possible intracranial pathologies can be overlooked and misdiagnosed as conversion disorder.…”

“…1 Acute stroke and conversion disorders are commonly confused with each other in the ED setting. 1 Medical literature reveals that possible intracranial pathologies can be overlooked and misdiagnosed as conversion disorder. 2,3 Although rare, some cases present to EDs with symptoms mimicking acute stroke and are diagnosed as conversion disorder.…”