A Multifaceted Diagnostic Journey from Seizure Disorder to Functional Neurologic Disorder
A 79-year-old male patient presented with a perplexing case of involuntary movements and transient unresponsiveness, leading healthcare professionals through a diagnostic labyrinth. Despite multiple evaluations and treatment adjustments, the patient’s condition remained elusive, underscoring the need for a multidisciplinary approach in managing complex neurological symptoms. What is the diagnosis?
HCN Medical Memo
This case serves as a reminder of the diagnostic challenges posed by complex neurological symptoms in elderly patients. It underscores the importance of a multidisciplinary approach, involving neurologists, primary care physicians, and imaging specialists, to arrive at an accurate diagnosis and effective treatment plan.
- The patient experienced involuntary movements for 9 months, initially lasting 1-2 minutes but later increasing to 10 minutes per episode.
- Sodium levels were consistently low at around 129 mmol per liter, with a history of inappropriate antidiuretic hormone secretion.
- MRI and EEG showed minor abnormalities, but no definitive signs of seizure activity.
- Treatment with levetiracetam initially considered for seizure disorder was later switched to clobazam due to the nature of the movements.
- The patient was finally diagnosed with a functional neurologic disorder after a series of complex evaluations.
Dr. Carrie Chui, a neurologist, emphasized the importance of considering a broad differential diagnosis in cases with complex neurological symptoms. Dr. Rajiv Gupta noted that imaging studies, including CT angiography, showed no evidence of acute territorial infarction, complicating the diagnostic picture.
- The patient had a complex medical history, including Barrett’s esophagus, benign prostatic hypertrophy, and chronic hepatitis B among others.
- The patient’s sodium levels and lactate levels normalized during his hospital stay, but episodes of involuntary movements continued.
- The patient was discharged with a recommendation for outpatient physical therapy and use of distraction techniques.
More on Epilepsy/Seizures