Dissociative paraplegia after epidural anesthesia: a case report

Journal of Medical Case Reports

Einar P Wilder-Smith¹  Norbert Weidner²  Robert C Wolf³  Philipp A Thomann³  Dusan Hirjak² 

[1] Division of Neurology, National University Singapore, Singapore;Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany;Center for Psychosocial Medicine, Department of General Psychiatry, Heidelberg University Hospital, Heidelberg, Germany

关键词: Neurology;    Psychiatry;    Spinal cord injury;    Conversion disorder;    Dissociative paraplegia;   

Others  :  1181263
DOI  :  10.1186/1752-1947-7-56

 received in 2012-10-23, accepted in 2013-01-16,  发布年份 2013

【 摘 要 】

Introduction

Clinicians are confronted with considerable difficulties in diagnosing conversion disorders such as dissociative paraplegia. In the literature, there is still no sufficient evidence regarding a typical pattern or general characteristics for this neuropsychiatric syndrome. Over the last decades case reports have described patients with similar personality traits, psychopathological characteristics, history and symptoms.

Case presentation

We present the case of a 67-year-old Caucasian woman of high economic status and educational level with no psychopathological symptoms and no history of mental disorders who developed dissociative paraplegia after epidural anesthesia. The neurological examination revealed incongruous features, and repeated spine magnetic resonance imaging was normal. Three years earlier the patient had transient paralysis of her left lower limb without detectable cause.

Conclusion

We identified an association between stressful life events and neurological anomalies. Crucial for the diagnosis of dissociative paraplegia is the neurological examination. Our case demonstrates that lack of psychopathological features and previous psychiatric diagnosis are not sufficient to exclude dissociative paraplegia. In patients with incongruous neurological findings and absent neurobiological correlates, clinicians should consider the presence of conversion disorders such as dissociative paraplegia.

【 授权许可】

   
2013 Hirjak et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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