Hirjak Dusan, Thomann Philipp A, Wolf Robert C, Weidner Norbert, Wilder-Smith Einar P
Structural Neuroimaging Group, Department of General Psychiatry, Heidelberg University Hospital, Voßstraße 4, Heidelberg, D-69115, Germany.
J Med Case Rep. 2013 Feb 27;7:56. doi: 10.1186/1752-1947-7-56.
Clinicians are confronted with considerable difficulties in diagnosing conversion disorders such as dissociative paraplegia. In the literature, there is still no sufficient evidence regarding a typical pattern or general characteristics for this neuropsychiatric syndrome. Over the last decades case reports have described patients with similar personality traits, psychopathological characteristics, history and symptoms.
We present the case of a 67-year-old Caucasian woman of high economic status and educational level with no psychopathological symptoms and no history of mental disorders who developed dissociative paraplegia after epidural anesthesia. The neurological examination revealed incongruous features, and repeated spine magnetic resonance imaging was normal. Three years earlier the patient had transient paralysis of her left lower limb without detectable cause.
We identified an association between stressful life events and neurological anomalies. Crucial for the diagnosis of dissociative paraplegia is the neurological examination. Our case demonstrates that lack of psychopathological features and previous psychiatric diagnosis are not sufficient to exclude dissociative paraplegia. In patients with incongruous neurological findings and absent neurobiological correlates, clinicians should consider the presence of conversion disorders such as dissociative paraplegia.
临床医生在诊断诸如分离性截瘫等转换障碍时面临着相当大的困难。在文献中，对于这种神经精神综合征的典型模式或一般特征仍没有足够的证据。在过去几十年里，病例报告描述了具有相似人格特质、精神病理学特征、病史和症状的患者。
我们报告一例67岁经济状况良好、教育程度较高的白种女性病例，该患者无精神病理学症状且无精神障碍病史，在硬膜外麻醉后出现分离性截瘫。神经系统检查发现了不一致的特征，多次脊柱磁共振成像均正常。三年前，患者曾出现左下肢短暂性麻痹，病因不明。
我们发现生活应激事件与神经异常之间存在关联。神经系统检查对于分离性截瘫的诊断至关重要。我们的病例表明，缺乏精神病理学特征和既往精神科诊断不足以排除分离性截瘫。对于神经系统检查结果不一致且无神经生物学相关性的患者，临床医生应考虑存在诸如分离性截瘫等转换障碍。
