Functional Neurological Symptom Disorder (FND) Leading to the Development of Deep Vein Thrombosis (DVT), 2022, Othman et al

Abstract

Functional neurological symptom disorder (FND) remains a clinical challenge. It is one of the many mimics of cerebrovascular accidents, spinal cord disorders, and lower motor neuron disease. Patients often undergo an extensive workup to exclude other causes of neurological dysfunction before the diagnosis is made. FND is often associated with weakness and paralysis, yet we could not locate a case depicting symptoms severe enough to cause venous thromboembolism. We present a patient diagnosed with FND who subsequently developed deep vein thromboses (DVT) of the bilateral lower extremities. She was placed on systemic anticoagulation and her functional symptoms improved with physical therapy (PT). This case describes the need for early PT to improve function and prevent complications related to functional immobility.

Open access, https://www.cureus.com/articles/101...o-the-development-of-deep-vein-thrombosis-dvt

 

FND always suggests to me that doctors can't find a physical problem so they blame the patient's mental state. I looked at the paper itself and found these issues with the patient's test data:

In blood:
Sodium is very low in range.
Potassium is below range.
BUN (Blood urea nitrogen, usually part of a kidney function test) is above range.
Bicarbonate (HCO3) is below range.
Anion gap is above range.
Vitamin B12 is very low in range.
Vitamin D is deficient.
CRP (marker of inflammation) is 10 times the top of the range.

In CSF:
Red blood cells found - they aren't supposed to be there.
Lymphocytes top of range suggesting an infection.

I think it should be fairly obvious to a medically trained person (something I'm not) that the patient is quite unwell, with so many of her test results on the border of the range or above/below range. But they decide this is functional???? I'd love to know how this woman could have made these changes to herself.

She ended up being offered CBT (which she declined) and physical therapy (which she started), and, hey presto, within just a few days she ended up with DVT in both legs, probably brought on by the physical therapy. Why couldn't they have given her electrolytes, since hers were obviously on the fritz, and checked the state of her kidneys further? And did they decide to improve her B12 or her vitamin D? It would appear not.

After the woman's second hospital admission a few days later (with the DVTs) :

The whole tenor of the paper suggests they are patient-blaming, particularly her mental health, and they are completely uninterested in her physical health.

I think this paper makes it official - doctors have completely given up trying to cure people.

 

Beyond parody.

 

How would the PT set off the DVT? I don't know anything about this topic.

In the paper are they suggesting it was her inactivity that caused these?

 

Yes. Her first presentation to hospital is described as follows :

I suspect that with previous inactivity and her dodgy electrolyte results that PT could have caused damage to muscles perhaps? Her circulation?

 

I actually wonder if part of the problems she is having stem from a vitamin B12 deficiency and possibly pernicious anaemia. In Japan, for example, treatment for B12 deficiency is started when the level drops below 500 (not sure of the units), whereas in the case of the patient described her B12 was 213 pg/mL.

According to this link, the symptoms of B12 deficiency are very diverse and include, amongst others, neurological and neuropsychiatric symptoms :

https://www.b12deficiency.info/signs-and-symptoms/