Close Your Eyes and See: Stroke Sequelae versus Functional Neurological Disorder in a Physician

• Type of Material: Article
• Authors: Ethel Jennifer Weil, Emory University; Harold Fletcher Keyserling, Emory University; Burt Feuerstein, University of Arizona; Olwen Murphy, Johns Hopkins University
• Language: English
• Date: 2023-04-20
• Publisher: Karger Publishers
• Publication Version: Final Published Version
• Copyright Statement: © 2023, Silverchair Publisher
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): https://doi.org/10.1159/000530753
• Title of Journal or Parent Work: European Neurology
• Volume: 86
• Issue: 4
• Start Page: 287
• End Page: 294
• Grant/Funding Information: There is no funding for this study.
• Keywords: Spinal trigeminal tract; Cerebellum; Atypical trigeminal neuralgia; Venous hemorrhage; Cavernous venous malformation; Functional neurological disorder; Medical epistemology; Middle cerebellar peduncle; Central vertigo
• Research Categories: Biology, Neuroscience; Health Sciences, General

Abstract

The first author is a left-handed, 51-year-old nephrologist who experienced a neurologic event. She underwent neurosurgery complicated by hemorrhage. Postoperatively, she developed persistent vertigo and unilateral tongue pain which persisted for over 5 years. Early neuroimaging revealed expected encephalomalacia but no neuroanatomical basis for her symptoms. A functional neurological disorder was suspected, and she was seen by several psychiatrists and psychotherapists. However, she suspected a neuroanatomical lesion would better explain her unrelenting symptoms. After seeing many neurologists, a neuroanatomical diagnosis was finally made. The theory and practice of medicine mandate that subjective complaint guides the modality and interpretation of objective evidence. The final neurologist knew where on neuroimaging to look because she was guided by the patient's complaints – vertigo and unilateral tongue pain. In this case, detailed scrutiny of neuroimaging by a neurologist, after encephalomalacia and gliosis were fully completed, gave a more accurate neuroanatomical diagnosis and a more realistic prognosis.