Factitious Seizures and Limb Paralysis in Munchausen Syndrome

Abstract

Munchausen syndrome is a rare factitious disorder, characterized by either the intentional manifestation of physical symptoms or repeated self-injuries in order to achieve health care attention, complemented by pathological lying and a restless wandering from hospital to hospital for medical and/or surgical interventions [1]. Along with wounds and psychic symptoms, one of the commonest presenting complaint is seizures [2]. Here, we document an interesting case, presenting as factitious psychogenic nonepileptic paroxysmal episodes and limb paralysis. An 18-year-old male visited the emergency room (ER) with postictal limbs paralysis. Witnesses reported that he suffered a generalized tonic seizure-like event, followed by paraplegia or quadriplegia on resumption of consciousness. Social history revealed that his parents divorced when he was 8 years old and he was subsequently raised by his grandmother. From 9 years of age, he frequently visited ER for varying complaints, including lower extremity arthralgia, chest palpitation, and dyspnea. However, investigations did not show any abnormality. Past surgical history consisted of three episodes of orthopedic surgery and an appendectomy with a grossly normal appendix. He developed his first paroxysmal behavior at the age of 13. While the clinical semiology was bizarre, with brief tremulous movements and the absence of drooling or lip cyanosis, his brain magnetic resonance imag