Functional Neurological Symptom Disorder (FND) Leading to the Development of Deep Vein Thrombosis (DVT)

Abstract

Functional neurological symptom disorder (FND) remains a clinical challenge. It is one of the many mimics of cerebrovascular accidents, spinal cord disorders, and lower motor neuron disease. Patients often undergo an extensive workup to exclude other causes of neurological dysfunction before the diagnosis is made. FND is often associated with weakness and paralysis, yet we could not locate a case depicting symptoms severe enough to cause venous thromboembolism. We present a patient diagnosed with FND who subsequently developed deep vein thromboses (DVT) of the bilateral lower extremities. She was placed on systemic anticoagulation and her functional symptoms improved with physical therapy (PT). This case describes the need for early PT to improve function and prevent complications related to functional immobility.

Keywords: deep vein thrombosis; functional neurological disorder; internal medicine; physical therapy; psychiatry.

Figure 1. Venous doppler US showing bilateral DVT

(A) Left peroneal vein (B) Right peroneal vein (C) Right posterior tibial vein (D) Left posterior tibial vein  US: Ultrasound; DVT: Deep vein thrombosis

Figure 2. Plain radiography of the chest showing a 2 cm hilar nodule

Figure 3. CT of chest with contrast showing the nodule discovered on plain radiography to be a pulmonary vessel

CT: computed tomography