Article Text

Download PDFPDF
Conversion Disorder Mimicking Dejerine-Roussy Syndrome (Thalamic Stroke) After Spinal Cord Stimulation
  1. F. Michael Ferrante, M.D.,
  2. Maunak V. Rana, M.D. and
  3. Margaret A. Ferrante, M.D.
  1. From the Pain Management Center, Department of Anesthesiology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA (F.M.F.)
  2. Department of Anesthesiology, Hospital of the University of Pennsylvania, Philadelphia, PA (M.V.R.)
  3. Departments of Anesthesiology and Radiology, Harbor/UCLA Medical Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA (M.A.F.)
  1. Reprint requests: F. Michael Ferrante, M.D., UCLA Pain Management Center, 1245 16th Street, Suite 220, Santa Monica, CA 90404 USA. E-mail: ferrante{at}mednet.ucla.edu

Abstract

Objective Dejerine-Roussy syndrome is a complex of various signs and symptoms in patients suffering from central thalamic pain, usually secondary to a vascular etiology. We describe a patient presenting with the potentially devastating signs and symptoms of thalamic stroke, at least temporally related to spinal cord stimulator implantation. The etiology of the patient's affliction was subsequently revealed to be a conversion disorder.

Case Report A 37-year-old woman presented for spinal cord stimulation as treatment of her brachial plexopathy after failure of conservative therapy. Before implantation, she underwent a clinical interview with a psychologist and psychometric testing. No psychological pathology was detected. Trial and permanent implantation of the cervical stimulator lead and pulse generator were uneventful. Eleven days after receiving the permanent implant, the patient experienced right-sided hemicorporal numbness and burning dysesthesia. The patient was admitted, and a diagnosis of Dejerine-Roussy syndrome (thalamic stroke) was made. She was discharged, and her symptomatology waxed and waned over a period of weeks. The patient was subsequently admitted for psychiatric evaluation because of anxiety attacks. During her protracted admission, her psychiatrists strongly suspected a conversion disorder. The stimulator was removed, and the patient received supportive care only. Within 6 months, sensory symptoms and all motor deficits had completely resolved.

Conclusions Despite careful preoperative evaluation, latent psychosocial issues may limit the effectiveness of spinal cord stimulation. We present a case of conversion disorder masquerading as Dejerine-Roussy syndrome after spinal cord stimulation. The implications of the failure of preoperative psychological evaluation and screening to avert implantation are discussed.

  • Conversion disorder
  • Dejerine-Roussy syndrome
  • Spinal cord stimulation
  • Central poststroke pain syndrome

Statistics from Altmetric.com

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.