Dissociative paraplegia after epidural anesthesia: a case report

Abstract

Introduction: 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.

Case presentation: 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.

Conclusion: 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.

Figure 1

Sagittal magnetic resonance imaging of the thoracic spine on day 1 after the abdominal surgery and epidural anesthesia. Note the absence of canal compromise, edema, and bleeding.

Figure 2

Sagittal magnetic resonance imaging of the thoracolumbar spine on day 5 after the abdominal surgery and epidural anesthesia. Note the absence of canal compromise, edema or bleeding.