Post-operative functional neurological symptom disorder after anesthesia

Abstract

A rare manifestation during the post-anesthetic period may include the occurrence of functional neurological symptom disorder (FNSD). FNSD is described as neurological symptoms that are not consistently explained by neurological or medical conditions. We report a case series consisting of six patients who underwent a general anesthetic at a tertiary referral hospital and experienced FNSD in the immediate post-anesthetic period. Life-threatening causes were excluded based on benign physical exam findings and knowledge of past history. Five of six cases manifested with FNSD only in the immediate post-operative setting after exposure to anesthesia, and never otherwise experienced these symptoms during their normal daily lives. MEDLINE and Google Scholar were searched through October 2019 using a highly-sensitive search strategy and identified 38 published cases of post-anesthetic FNSD. Meta-analysis of pooled clinical data revealed that a significant proportion of patients were females (86%), reported a history of psychiatric illness (49%), reported a prior history of FNSD (53%), and underwent general anesthesia as the primary anesthetic (93%). The majority of patients were exposed to diagnostic studies (66% received radiographic tests and 52% received electroencephalogram) as well as pharmacologic therapy (57%). While no deaths occurred, many patients had unanticipated admission to the hospital (53%) or to the intensive care unit (25%). These data may help inform the anesthesia literature on presentation, risk factors, and treatment outcomes of FNSD in the context of anesthetic administration. We contemplate whether anesthetic agents may predispose a vulnerable brain to manifest with involuntary motor and sensory control seen in FNSD.

Conversion disorder upon emergence from general anesthesia—A case report and review of literature

“…CD is associated with poor prognosis with a large proportion of patients having a residual deficit, the longer the duration to reach a diagnosis the worse the prognosis. [ 12 13 ] Probably, this patient presented hysteria with paraplegia symptoms.…”

Functional Neurological Symptom Disorder: A Continuing Conundrum for the Perioperative Physician

“…The review suggested that procedures involving anesthesia were relatively common triggers for the development of FNSD. FNSD has been described after moderate sedation, neuraxial anesthesia, and general anesthesia [5][6][7][8][9][10]. Deficits that have been reported include monoplegia, hemiplegia, paraplegia, quadriplegia, amnesia, aphonia, delayed awakening, blindness, deafness, and seizures.…”

“…Deficits that have been reported include monoplegia, hemiplegia, paraplegia, quadriplegia, amnesia, aphonia, delayed awakening, blindness, deafness, and seizures. It has been contemplated whether anesthetic agents or the anesthetized state predispose a vulnerable brain to manifest these symptoms and signs [ 1 , 5 , 6 ]. Although the existence of psychological factors, such as conflicts or stress, are common and judged to be associated with the deficits [ 4 ], they are not universally present [ 2 ].…”

A Case Report of “Propofol Frenzy”: Anesthetic Considerations for a Severe Propofol-Induced Neuroexcitation Reaction

“…In comparison, patients with postoperative conversion paralysis were found to have a median symptom duration of 3 days. 12 In addition, a recent case series reported 5 of 6 patients having a previous FND spell(s) only after exposure to anesthetics (ie, no symptoms at home). 12 Currently, the relationship between anesthetic agents predisposing patients to FND remains unknown.…”