Functional Neurological Disorder Presenting as Stroke: A Narrative Review

Abstract

Functional neurological symptom disorder (FNSD) represents one of the disorders that are continuously being revised by the diagnostic and statistical manual of disease (DSM) due to the lack of certainty of some of its clinical characteristics. In the last 5 th edition (DSM5), 7 subtypes have been proposed, but not all of them potentially present as stroke mimics. Though both FNSD and stroke are common in clinical practice, the prevalence of functional stroke is not well-known. The diagnosis of FNSD does not rely on the mere absence of medical explanation, but on active demonstration of symptom incompatibility with a medical disorder. In this narrative review, we explore the literature on the prevalence of functional stroke, its clinical presentation and the validated clinical signs of incongruity, the risk factors and cultural differences of clinical presentation and differentiation of FNSD from malingering. We also review the role of neuroimaging in establishing the diagnosis as well as the evidence of thrombolysis safety and some of the psychosomatic models of disease.