Berry Alex J, Wiethoff Sarah
Division of Psychiatry, University College London (UCL), Bloomsbury, UK.
Institute of Neurology, University College London (UCL), London, UK.
Oxf Med Case Reports. 2020 Sep 22;2020(9):omaa073. doi: 10.1093/omcr/omaa073. eCollection 2020 Sep.
We report a case of a 62-year-old female diagnosed with functional neurological disorder (FND), where the diagnosis was eventually revised to progressive supranuclear palsy 3 years after symptom onset. FND is a commonly encountered condition and can be diagnosed with a considerable degree of confidence in most cases. FND is associated with significant functional impairment and may occur alongside other neurological disorders, and there is now a growing evidence base for symptom-specific FND treatments. Charting clinical progression of symptoms and serial neuroimaging were useful in refining the diagnosis in this case. Alhough the diagnosis was ultimately revised to a neurodegenerative disorder, a degree of functional overlay likely remained present. The case highlights the importance of recognizing and avoiding diagnostic overshadowing in those with FND.
我们报告了一例62岁女性患者，最初被诊断为功能性神经障碍（FND），但在症状出现3年后最终诊断被修订为进行性核上性麻痹。FND是一种常见病症，在大多数情况下可以有相当把握地做出诊断。FND与严重的功能损害相关，可能与其他神经系统疾病同时发生，目前针对特定症状的FND治疗的证据基础正在不断扩大。记录症状的临床进展和系列神经影像学检查有助于在该病例中完善诊断。尽管最终诊断被修订为神经退行性疾病，但可能仍存在一定程度的功能叠加。该病例凸显了认识并避免对FND患者进行诊断遮蔽的重要性。
