Conversion Disorder in the Peripheral Nerve Surgery Setting: A Report of Two Cases and a Review of the Literature.
Gerlinde S Heil, MD
Spital Thun, Thun, Switzerland
Objective: To report and discuss two cases of conversion disorder presenting as peripheral nerve dysfunction to raise awareness, point out critical diagnosic steps and to guide appropriate treatment (to cut down cost and harm).
Summary of Background Data: Conversion disorder presenting in form of peripheral nerve dysfunction is often associated with costly diagnostic assessment. Patients clinically suffer from a loss of motor function. Causes are multifarious from onset after a traumatic event to chronic (emotional) stress. The prevalence of conversion disorder in the general population reportedly ranges between 0.01% to 0.5%. The early diagnosis of conversational disorder can rescue both the patient and physician from conducting unnecessary tests and treatments. This will also be helpful to cut health expenses in these cases.
Methods: We retrospectively reviewed the medical record of two patients who presented to the authors’ service reporting nerve motor deficit without proven neurological pathophysiology. We also analyzed related laboratory, electrodiagnostic, and imaging studies. None of the patients reported a history of recent trauma. One had a history of previous military service in Iraq.
Results: The two patients had physiological laboratory, electrodiagnostic, and imaging studies. Clinical symptoms included foot motor deficit, clutched hand syndrome, and arm paralysis without associated sensory deficit. The patients were educated about the normal test results and physical examination inconsistencies as well as the benign character of their symptoms and were referred for psychological workup.
Conclusion: Dysfunction of peripheral nerves can be a symptom of conversion disorder. It is a diagnosis of exclusion that may appear at any age but is most common in adolescence. The onset of symptoms is mostly sudden following a major stress in the patient's life. Most patients suffer from only one symptom. It is important to inform the patient in a nonjudgmental way that the examinations did not reveal any pathophysiology. The symptoms tend to disappear without any therapy in a few weeks.
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