Yokono A, Yokono S, Ogli K, Yamanobe K, Kondo A
Department of Anesthesiology and Emergency Medicine, Kagawa Medical School.
Masui. 1991 Feb;40(2):306-12.
We report a case of hysterical conversion, which was initially diagnosed as trigeminal neuralgia. The pain in the face and head which the patient complained seemed to be consistent with symptoms of trigeminal neuralgia. But it could not be relieved by repeated peripheral nerve blocks and even by Gasserian blocks. Failure to relieve pain by such blocks and concomitant hemifacial spasm with closure of the eye appeared to afford indication of microvascular decompression surgery. Injection of edrophonium before operation, for the purpose of differential diagnosis of myasthenic ptosis, made the patient free from all symptoms, i.e. facial pain, spasm, and ptosis. The diagnosis of hysterical conversion was made on this irrational episode. When we looked back the total clinical course, it was revealed that the patient's complaints and symptoms had been rather atypical, too various, and not anatomical. We also confirmed that various other episodes of this patient which had not received our attention during treatment were psychological features of hysteria, but we could not make his psychological stress clear, which had been in the background of hysterical conversion.
我们报告一例癔症性转换障碍病例，该病例最初被诊断为三叉神经痛。患者主诉的面部和头部疼痛似乎与三叉神经痛的症状相符。但反复进行外周神经阻滞甚至半月神经节阻滞均无法缓解疼痛。这些阻滞未能缓解疼痛，且伴有患侧面部痉挛及眼睑闭合，这似乎提示需要进行微血管减压手术。术前注射依酚氯铵以鉴别重症肌无力性上睑下垂，结果使患者的所有症状（即面部疼痛、痉挛和上睑下垂）均消失。基于这一不合理的情况，做出了癔症性转换障碍的诊断。回顾整个临床过程发现，患者的主诉和症状相当不典型、过于多样且不符合解剖学特征。我们还证实，该患者在治疗期间未引起我们注意的其他各种情况均为癔症的心理特征，但我们无法明确其作为癔症性转换障碍背景的心理压力。
