Conversion disorder mimicking dejerine-roussy syndrome (thalamic stroke) after spinal cord stimulation

• Published in: Regional anesthesia and pain medicine Vol. 29; no. 2; pp. 164 - 167
• Main Authors: Ferrante, F.Michael, Rana, Maunak V, Ferrante, Margaret A
• Format: Journal Article
• Language: English
• Published: England Elsevier Inc 01.03.2004; BMJ Publishing Group LTD
• Subjects: Adult; Brachial Plexus Neuropathies - therapy; Central poststroke pain syndrome; Conversion disorder; Conversion Disorder - diagnosis; Conversion Disorder - physiopathology; Dejerine-Roussy syndrome; Diagnosis, Differential; Electric Stimulation Therapy - psychology; Female; Follow-Up Studies; Humans; Hypesthesia - physiopathology; Paresthesia - physiopathology; Regional anesthesia; Spinal Cord; Spinal cord stimulation; Thalamic Diseases - diagnosis; Thalamic Diseases - physiopathology; Conversion disorder; Central poststroke pain syndrome; Dejerine-Roussy syndrome; Spinal cord stimulation
• ISSN: 1098-7339; 1532-8651
• DOI: 10.1016/j.rapm.2003.12.014

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. 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. 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.