Cerebral infarction due to thrombosis mistaken as dissociative motor disorder
ISSN
0025-1097
Date Issued
2024-04
Author(s)
Petrovska Cvetkovska Dragana
PHI University Clinic for Neurology Skopje, North Macedonia
Petar Sotirovski
PHI University Psychiatric Clinic - Skopje
Nedelkovska, Aleksandra
PHI Health Center – Emergency unit, Skopje, R. N. Macedonia
Ivanoski, Slavcho
Special Hospital “St. Erasmus”, Ohrid, R. N. Macedonia
Abstract
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.
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.
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