Post-operative Incomplete Quadriplegia Caused by Conversion Disorder in a Female After Gynecological Surgery: A Case Report 2022 McCrackin & Weiss

Andy

Andy

Retired committee member
Abstract

Conversion disorder (CD) is a psychological disease that presents as neurologic symptoms. This diagnosis of exclusion can include symptoms such as paralysis, blindness, non-epileptic seizures, and movement disorders. We describe a case of a healthy 39-year-old woman who underwent a laparoscopic hysterectomy with a routine general anesthetic and developed incomplete quadriplegia and urinary incontinence post-operatively. Her labs and imaging were all within normal limits and neurology felt her presentation was inconsistent with most organic neurological insults. One month later, she received a diagnosis of conversion disorder.

Open access, https://www.cureus.com/articles/935...ale-after-gynecological-surgery-a-case-report
 
Did these physicians rule out myasthenia gravis? Could it be a possibility?

I find it incredibly sad for the patient to have post-op deficits that are not typical of the surgery performed and that it is believed to be all in her head. And what more, the paper seem to be extremely identifying for the patient herself.

What makes it much worse for me is that the 2 authors are women.
 
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The authors don't seem to have a modern understanding of FND. We don't call it conversion disorder anymore. If I understand the modern research, it points to an issue in the brain, perhaps with connectivity, so it's unsurprising that moods/stress can be involved. (Mental states affect my tics but nobody calls those "functional" or "psychosomatic") It's obviously way more than stress manifesting in the body...that's always been a lazy and reductionist point of view. If you can't move your legs (etc.) something that physically exists somewhere must be malfunctioning.
 
Well that is one creative way to account for issues caused by a major surgery. It's frankly morbid to actually blame incontinence after a total hysterectomy on psychological, uh, well psychological disease is not a thing.

And it speaks of quadriplegia but she recovered limb movement quickly.

In the end this is really nothing but a "we don't know, so it must be that", which is itself justified by a tradition of doing that. Medicine is seriously going to get much worse before it gets better. What a scandal this will do one day.
 
Milo said:
Did these physicians rule out myasthenia gravis? Could it be a possibility?

I find it incredibly sad for the patient to have post-op deficits that are not typical of the surgery performed and that it is believed to be all in her head. And what more, the paper seem to be extremely identifying for the patient herself.

What makes it much worse for me is that the 2 authors are women.
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Indeed this made me think of the pernicious anemia thing with general anaesthesia etc. I was surprised the paper didn't note that was checked for specifically?
 
From the case report :

A 39-year-old, 70 kg Caucasian female with a past medical history of asthma, migraines, and anxiety, underwent an elective total robotic hysterectomy and bilateral salpingectomy for uterine fibroids
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Why didn't they just remove the fibroids instead of spaying/neutering her? It feels a bit like amputating a leg in someone with chilblains. And is anxiety really a good reason for this surgery? It sounds more like she is being punished for being female rather than being treated for the only gynaecological problem she has (i.e. the fibroids).
 
Arnie Pye said:
From the case report :



Why didn't they just remove the fibroids instead of spaying/neutering her? It feels a bit like amputating a leg in someone with chilblains. And is anxiety really a good reason for this surgery? It sounds more like she is being punished for being female rather than being treated for the only gynaecological problem she has (i.e. the fibroids).
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Because fibroids can bleed or grow back and she may have decided her best option at that stage in her life was to return the part to the manufacturer. The decision to proceed is obviously between the patient and her doctor.
 
OK I've gone so far as to google injuries related to this and quickly there was a list including the following: https://gynecolsurg.springeropen.com/articles/10.1186/s10397-021-01086-7

which talks of femoral nerve injuries, sounds possible and symptoms (and the period of time - in that it can resolve over many months, but sometimes not) you'd think it would be these things that would be talked about and ruled out?

I then looked up whether these show on tests: https://www.mountsinai.org/health-library/diseases-conditions/femoral-nerve-dysfunction
Tests that may be done include:

  • Electromyography (EMG) to check the health of the muscles and the nerves that control the muscles.
  • Nerve conduction (NCV) tests to check how fast electrical signals move through a nerve. This test is usually done at the same time as an EMG.
  • MRI or CT scan to check for masses or tumors.
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The article talks of an MRI of the spine, and of electromyography in general 'in the normal range' but I don't know enough to know whether that phraseology used by the authors in the papers covers this condition.
 
From the case report :

A 39-year-old, 70 kg Caucasian female with a past medical history of asthma, migraines, and anxiety, underwent an elective total robotic hysterectomy and bilateral salpingectomy for uterine fibroids
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Surgery, including those involving anaesthesia, as the patient underwent, can cause MRI/CT non-visible non-traumatic injuries. The organic neurological insults that were ruled out should be evidenced, and the others they didn't rule out should be explained before considering conversion disorder, at least.
 
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Milo said:
Because fibroids can bleed or grow back and she may have decided her best option at that stage in her life was to return the part to the manufacturer. The decision to proceed is obviously between the patient and her doctor.
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We aren't told who decided the patient should have a hysterectomy complete with the removal of her ovaries, or what information the patient was given to "help" her make a decision about her treatment.

I have read many reports of women going into gynaecological surgery for, say, an ovarian cyst removal in the USA, and the woman wakes up to discover that the surgeon has removed her uterus and both ovaries. The woman may not have given her permission for this, and some women have taken surgeons to court for doing such major and life-altering surgery without permission, but as is so very common with women's health, the women often lose their case.

I am aware that surgeons who operate on men with testicle damage from car accidents move heaven and earth to save what they can. But ovaries are basically considered to be about as important as a used medical swab, and the woman is just expected to put up and shut up.

Also, the NHS mentions quite a few possible treatments for fibroids... hysterectomy is just one.

https://www.nhs.uk/conditions/fibroids/
 
Macleans: said:
BRAIN INJURY SETTLEMENT

Canada NOTES

A woman who emerged from minor surgery severely brain-damaged was awarded $5.1 million in an out-of-court settlement. Claire Coombs of Brampton, Ont., now 34, received 10 times the recommended dosage of anesthetic when she entered a hospital in 1994 to have two wisdom teeth removed. As a result, Coombs is a quadriplegic without bodily function, fed through a tube inserted in her stomach. The money will be used to pay for the round-theclock care she will require for life.

http://archive.macleans.ca/article/1998/4/27/brain-injury-settlement
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FND lead researchers also say it can start following physical injury as well. Patients need protection.
 
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