Document Detail


Conversion sensory symptoms associated with parietal lobe infarct: case report, diagnostic issues and brain mechanisms.
MedLine Citation:
PMID:  11944507     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
This case report suggests that diagnostic difficulties and brain mechanisms related to conversion disorder associated with cerebral lesions differ from those related to conversion disorder without cerebral lesions. A 35-year-old divorced woman was admitted to a psychiatric inpatient unit with multiple physical complaints. The symptoms first appeared 5 years previous and 2 months after a sexual assault. Three years later, she began to experience ill-defined sensory symptoms confined to the left half of her body (splitting the midline). Results of neurologic consultations were equivocal because of the subjective nature of the complaints, which were viewed as conversion symptoms. A magnetic resonance imaging scan demonstrated an old infarct in the right parietal lobe, suggesting a physical origin of the patient's symptoms. However, normal somatosensory-evoked responses from the affected area contributed little to establishing the diagnosis. The results of all further investigations to identify causes of the vascular pathology were negative. The multiple ill-defined somatic symptoms, the distribution of sensory symptoms and the resolution of symptoms with psychotherapy established the diagnosis of conversion disorder superimposed on a pre-existing right parietal lesion. This case highlights the importance of clinical features in establishing a diagnosis such as this. We suggest that reactivation of implicit sensory memories (represented at the thalamic level and resulting from decreased corticofugal inhibitions due to the lesion) may contribute to the formation of sensory conversion symptoms in individuals with parietal lobe lesions.
Authors:
Rajamannar Ramasubbu
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Publication Detail:
Type:  Case Reports; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of psychiatry & neuroscience : JPN     Volume:  27     ISSN:  1180-4882     ISO Abbreviation:  J Psychiatry Neurosci     Publication Date:  2002 Mar 
Date Detail:
Created Date:  2002-04-11     Completed Date:  2002-10-21     Revised Date:  2013-04-18    
Medline Journal Info:
Nlm Unique ID:  9107859     Medline TA:  J Psychiatry Neurosci     Country:  Canada    
Other Details:
Languages:  eng     Pagination:  118-22     Citation Subset:  IM    
Affiliation:
Department of Psychiatry, Foothills Medical Centre and University of Calgary, Calgary, Alta. rajamannar.ramasubbu@calgaryhealthregion.ca
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MeSH Terms
Descriptor/Qualifier:
Adult
Cerebral Infarction / diagnosis,  physiopathology*,  psychology
Conversion Disorder / diagnosis,  physiopathology*,  psychology
Diagnosis, Differential
Dominance, Cerebral / physiology*
Evoked Potentials, Somatosensory / physiology
Female
Humans
Magnetic Resonance Imaging*
Neurologic Examination
Paresthesia / diagnosis,  physiopathology*,  psychology
Parietal Lobe / physiopathology*
Patient Care Team
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