Modification of both functional neurological symptoms and neuroimaging patterns with a good anatomoclinical concordance: a case report, 2019, Galli et

[Andy]

Background
In the nineteenth century, Jean Martin Charcot explained functional neurological disorder (formerly called conversion disorder) as a “psychodynamic” lesion. Numerous advances in neuroimaging have permitted identification of the neural underpinnings of this disorder.

Case presentation
Herein we describe a case of functional neurological disorder (FND) with initial left sensorimotor deficit, in-coordinated limb movements, neglect, clouded consciousness, slurred speech and a semiology of visual impairment. A single photon emission computed tomography (SPECT) showed a right thalamic hypoperfusion, which is rather concordant with the initial semiology. Later, the semiology changed, presenting with a predominantly neurovisual complex presentation. The second SPECT showed no more thalamic abnormalities but an hypoperfusion in the right temporo-occipital junction, right inferior parietal lobe and left superior frontal lobe, which is also rather concordant with the changing semiology.

Conclusions
This case illustrates the evolving neuroimaging patterns of FND but also the concordance between semiology and neuroimaging findings in FND supporting Charcot's theory of “dynamic lesion”.

Open access, https://bmcneurol.biomedcentral.com/articles/10.1186/s12883-019-1475-3

 

[rvallee]

In the nineteenth century, Jean Martin Charcot explained functional neurological disorder (formerly called conversion disorder)

I kind of like those papers that just say plainly what they mean and make it all super awkward for the people who try to pretend that it's not what it means even though of course that's exactly what they mean.

Bizarre that it comes here from a paper that argues for observed physiological changes when the whole point of conversion disorder is precisely no involvement from physiology. It's a lesion, but psychologically induced? Is hypoperfusion really indicative of lesions? Is it really a lesion if it changes "later" (not clear when that later is).

This is a complicated case with head trauma prior to the SPECT:

A 43 year-old right-handed woman with medical history of episodic depression presented with transient memory and attentional deficits after an episode of a gastric bleeding. She also reported episodes of lacunar amnesia and another kind of episode with sudden loss of consciousness and hypotonia, lasting for 3 or 4 min, which looked like sleep attacks.

Three months after symptoms-onset, one of these transient episodes induced a car accident with a minor head trauma (normal score in the initial Glasgow Coma Scale). The day after the accident, partial visual loss of the left eye, left tinnitus, partial left hearing loss and weakness of the left arm occurred. and two months later, she developed a speech disorder. She was then referred to the Neurology Departement of Besançon.

No idea where someone gets the idea that there is "conversion disorder" here. The level of confusion is very high.

 

[Mithriel]

It is so weird that they call it an emotionally based illness because there are no physical signs but then demonstrate physical signs to confirm they are right