Dissociative paraplegia after epidural anesthesia: a case report
Dusan Hirjak1, Philipp A Thomann, Robert C Wolf
1Structural Neuroimaging Group, Department of General Psychiatry, Heidelberg University Hospital, Voßstraße 4, Heidelberg, D-69115, Germany. dusan.hirjak@med.uni-heidelberg.de.
Journal of Medical Case Reports
|March 1, 2013
Summary
Dissociative paraplegia can occur without prior psychiatric history. Neurological examination is key to diagnosing this conversion disorder, even with incongruous findings and normal imaging.
Area of Science:
- Neuroscience
- Psychiatry
- Neurology
Background:
- Conversion disorders, like dissociative paraplegia, present diagnostic challenges for clinicians.
- Limited evidence exists on typical patterns or characteristics of this neuropsychiatric syndrome.
- Previous case reports suggest common personality traits, psychopathology, and symptom profiles.
Purpose of the Study:
- To present a case of dissociative paraplegia in a patient without prior psychopathological symptoms.
- To highlight the diagnostic considerations for conversion disorders in atypical presentations.
Main Methods:
- Case report of a 67-year-old woman with no history of mental disorders who developed dissociative paraplegia.
- Detailed neurological examination revealing incongruous findings.
- Repeated normal spine magnetic resonance imaging (MRI).
Main Results:
- The patient developed dissociative paraplegia following epidural anesthesia.
- Neurological examination showed incongruous features inconsistent with organic causes.
- No neurobiological correlates were identified despite symptoms.
Conclusions:
- Stressful life events may be associated with neurological anomalies in conversion disorders.
- Neurological examination is critical for diagnosing dissociative paraplegia.
- Absence of psychopathological features or prior psychiatric diagnosis does not rule out dissociative paraplegia.
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