McPherson Regina J, Santos-Rivera Juan R, Fonarov Ilya
Medicine, Florida International University, Herbert Wertheim College of Medicine, Miami, USA.
Internal Medicine, Ponce Health Sciences University, Ponce, PRI.
Cureus. 2025 Jul 24;17(7):e88648. doi: 10.7759/cureus.88648. eCollection 2025 Jul.
Functional neurological disorders (FNDs) continue to pose diagnostic challenges, often resembling organic neurological conditions and leading to extensive but unnecessary testing. FNDs commonly present with motor and sensory symptoms that fluctuate and improve with distraction, favoring differentiation from structural diseases. This case describes a 53-year-old female with bilateral lower extremity pain and toe contractures, initially concerning for an organic movement disorder or peripheral neuropathy. Examination revealed distractible dystonia, normal strength, and negative neuroimaging, supporting a diagnosis of FND. Despite prior similar presentations, diagnostic uncertainty and the presence of comorbid conditions such as diabetic peripheral neuropathy complicated the evaluation. Our report emphasizes the importance of recognizing positive clinical signs, reducing reliance on exclusion-based diagnosis, and addressing stigma to improve patient care and management.
功能性神经障碍（FNDs）仍然带来诊断挑战，常常类似于器质性神经疾病并导致广泛但不必要的检查。FNDs通常表现为运动和感觉症状，这些症状会因注意力分散而波动和改善，这有助于与结构性疾病相鉴别。本病例描述了一名53岁女性，患有双侧下肢疼痛和脚趾挛缩，最初怀疑是器质性运动障碍或周围神经病变。检查发现有可分散注意力的肌张力障碍、肌力正常且神经影像学检查阴性，支持FND的诊断。尽管之前有过类似表现，但诊断的不确定性以及糖尿病周围神经病变等合并症的存在使评估变得复杂。我们的报告强调了识别阳性临床体征、减少对基于排除法诊断的依赖以及消除污名化以改善患者护理和管理的重要性。
