Nevena Nikolova

Preferred name
Nevena Nikolova
Email
nevena.nikolova@medf.ukim.edu.mk

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    Item type:Publication,
    Pathological fracture of femur due to metastatic follicular thyroid carcinoma
    (Scientific Foundation SPIROSKI, 2022-05)
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    Cerebral infarction due to thrombosis mistaken as dissociative motor disorder
    (Македонско лекарско друштво = Macedonian Medical Association, 2024-04)
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    Petrovska Cvetkovska Dragana
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    Petar Sotirovski
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    Nedelkovska, Aleksandra
    Patient history: female patient 33 years old, with sudden loss of consciousness previous day, inability to talk and right-sided motor weakness. Emergency unit doctors found TA-110/70 mmHg, HR= 74/min, glycemia 7,1mmol/L, oxygen saturation- 96%. During several hours of neurologic symptoms were fluctuating with improvement of the motor deficit and speech ability. Computerized tomography (CT) was described without any changes so patient was dismissed with Dg: F44.4 (dissociative motor disorder) Hemiparesis lat.dex (susp. functionalis) and ordered to do electroencephalography, laboratory test and psychiatrist consultation. The next day psychiatrist was consulted, and motor deficit as light right-sided hemiparesis was obvious with right sided drooping mouth, loss of nasolabial fold, with dysarthria (slurred speech). She presented worries about her somatic illness. Electroencephalography was performed that revealed groups and intervals of slow waves over the left frontal-temporal regions. The patient was urgently referred to a neurologist for further investigation and treatment. Initial CT exhibited only mild hypodensity in the left basal ganglia and the left perisylvian region. MRI performed the following day shows a hypointense signal in T1, hyperintense signal in T2, and FLAIR pulse sequences involving the left caudate nucleus, left lentiform nucleus, part of the left frontal, left temporal and left insular lobe. A marked diffusion restriction with low ADC map values exists in the same areas. Findings are consistent with acute ischemic stroke in the left MCA territory. Such cases need to be urgently treated by neurologists and the fluctuating symptoms need to be followed over time. Knowledge about biological markers and neuroimaging is necessary for psychiatrists and close cooperation with neurologists is needed. After performing another CT with angiography with marked hypodense lesions, the patient was admitted and treated at the neurology clinic and dismissed fully recovered.