A diagnostic challenge in an unresponsive refugee child improving with neurosurgery—a case report

Abstract

An unresponsive paediatric patient may present a diagnostic challenge for health professionals, as rapid identification of the cause is needed to provide proper interventions. The following report details a challenging diagnosis of unresponsiveness in a refugee child. In the migratory context, observed unresponsiveness states are frequently attributed to psychologic factors, and overlapping psychiatric classifications (resignation syndrome, functional coma and catatonia) are common. Our patient fell into an unresponsive state for 6 months after witnessing a traumatic event. Diagnostic workup for multiple medical comorbidities led to surgical intervention for tethered cord syndrome. Shortly after that, the patient’s responsiveness improved, putting to question her condition’s underlying cause. This case highlights the need for a biopsychosocial approach in such cases, reflected in thorough clinical examination and diagnostic investigations. A multidisciplinary perspective and expertise proved crucial and may help in the rehabilitation of children in similar situations.

The neurobiology of functional neurological disorders characterised by impaired awareness

“…Specifically, the literature suggests that mechanisms underpinning attention, emotional processing and interoception could contribute to the altered perception of internal and external states (160)(161)(162)(163)(164)(165)(166)(167)(168)(169)(170)(171)(172)(173)(174)(175)(176)(177)(178)(179). Computational models explaining how the embodied brain responds to psychosocial stressors can be reconciled with recent neuroscience evidence on the above-mentioned mechanisms (180)(181)(182)(183).…”