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Re: Case Presentation #3
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Re: Case Presentation #3 - June 17, 2003 3:25:00 PM
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axon
Posts: 41
Joined: March 2, 2003
From: Illinois, USA
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[QUOTE]Originally posted by Bournephysio:
[B]Conversion disorder. I new it had a different name now.
YES!! Conversion disorder. Why did I say somatoform? Conversion disorder patients would probably be very much unattached to the fact that they woldn't feel bandage shears in their nail beds. A possible spinal cord injury patient would freak out. I would!
Sam B
(ignore somatoform, thanks! i think its easy to confuse the two, but they are very different)
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Re: Case Presentation #3 - June 17, 2003 5:19:00 PM
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prohealth
Posts: 16
Joined: June 12, 2003
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Very interesting! So, we have all our radiographs, CT, MRI negative.
I am still stuck on the cause of the accident- any hx of epilepsy? No matter what I do feel a neuropsych consult is warranted in a MVA/ trauma case even if it is to help cope with the condition now. I thought the sphincter tone was good- meaning 'normotonic'.
1. What about proprioception, kinesthesia or vibration sensation/ tactile discrimination (posterior columns)?
2. What segmental distribution can we attribute the anesthesia to- what about thermal sensation (lateral tract)?
3. Acute onset of symptoms after accident or, any prior history (neurosyphilis) and now we are confused with this MVA? Is MVA the cause for her paraplegia?
4. Brown-Sequard's syndrome- hope I have the spelling right? It will show affliction of the posterior columns, lateral (spinothalamic) tract, and signs of corticospinal tract defect below the lesion..
Still, no abnormalities detected in the scans? I need to brush-up on my limbic system!
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Re: Case Presentation #3 - June 17, 2003 5:29:00 PM
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Dr.Wagner
Posts: 1242
Joined: January 24, 2003
From: Indianapolis
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At the end of the day, the patient was easily tucked into bed, the steroids were flowing, and the patient was absolutely stable. A repeat MRI was scheduled for the morning...which was also completely normal. She simply WALKED out of the hospital the next day, she layed still all night...until WHAMMO "Get up and walk"...she did.
Conversion Disorder: a diagnosis of exclusion which the patient psychologically produces (typically) acute motor or sensory loss. The patient is not consciously producing the syptoms.
That is what happened. By the time the patient had the MRI, I had a feeling something was going on...even before that I guess. The very distinct intact rectal tone was odd, that is exactly why I tried on several occasions to elicit pain. Don't get me wrong, I use the nailbed technique always to get an appropriate GCS, but because of her PRISTENE exam and appearance, I had a feeling something wasn't fitting. It just doesn't happen that way in real life...not even in 100 cases. Oh and by the way, I am sure she won't pay all her bill.
Her accident, well...either on purpose or an honest accident. Nonetheless, her follow up was with psych and no one else.
Trauma: Life in the ER
[This message has been edited by Dr.Wagner (edited June 17, 2003).]
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Re: Case Presentation #3 - June 17, 2003 5:33:00 PM
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DcK
Posts: 17
Joined: April 9, 2003
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Good case Doc! I'd never guessed conversion.. I guess it's so far out of my scope I don't even consider stuff like that. [IMG]http://www.rehabedge.com/forums/smile.gif[/IMG]
That's fun though!
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Re: Case Presentation #3 - June 17, 2003 7:06:00 PM
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prohealth
Posts: 16
Joined: June 12, 2003
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Great case Doc!
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Re: Case Presentation #3 - June 18, 2003 12:10:00 PM
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Diane
Posts: 1507
Joined: March 9, 2001
From: Vancouver, B.C., Canada
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This is one of the most amazing stories of neuroplasticity and cortical downregulation of pain that I ever heard. Is she MPD?
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Re: Case Presentation #3 - June 18, 2003 5:24:00 PM
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Dr.Wagner
Posts: 1242
Joined: January 24, 2003
From: Indianapolis
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What? She is crazy...this is a wonderful example of conversion disorder. Many of the other great psych diagnosis I see daily [IMG]http://www.rehabedge.com/forums/smile.gif[/IMG]
Hell, I could tell you about the other crazy guy that took a knife and cut off his own testicles and penis...no drugs, no pot, no alcohol...just all crazy. He was as calm as can be.
Fun fun fun [IMG]http://www.rehabedge.com/forums/wink.gif[/IMG]
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