Another Misleading Patient: Is it Psychiatric? Is it Neurological?
A female patient, 36, was going from door to door for a full month, and was being sent back home with one comment she heard “It is probably conversion”.
What does Conversion mean? This is the name given to a psychiatric table that imitates any neurological disorder. It is always triggered by a stress .
But what was our patient’s condition? As a matter of fact, there was a serious stressor at the beginning of the disorder. She had considerable debts. On the other hand, a significant amount of money they were supposed to receive was not paid in time. Thus, they were in debt and could face enforcement any time. During those days, she suddenly started to show altered mental status. Yet, most of the time, she was behaving normally.
While listening closely, the patient was pissing herself, biting her tongue and showing other epileptic characteristics. Her attitudes and behaviors were already like a boxer in shock after getting punched.
Before long, an ordinary EEG would reveal everything. The patient was producing a constant electrical discharge from the back of her head.
The name of the picture was “non-epileptic status” .
A neurological consultation was requested immediately. As two physicians, we confirmed the diagnosis. The EEG got better in minutes through the use of a benzodiazepine-like drug, and clinical recovery started within a couple of hours.
The underlying reason, or etiology, is still being researched.
In short, this phenomenon shows:
First; the patient must always be listened to with great care and away from all kinds of prejudice. What caused a prejudice here is the company of a stress factor. It immediately directs physicians to conversion. Lack of attention is the background behind the reason why the patient pissed herself and bit her tongue. Relatives of the patient provide this information only when asked to. Unfortunately, this simple rule in this patient was overlooked for a month. Yet, these two symptoms are of great importance to diagnose epilepsy.
Second; a routine EEG, also known as brain radiography was not implemented. EEG, a known, simple and harmless method, prevents many possible brain disorders from getting overlooked.
Moreover, I cannot help thinking “Is there a problem in specialty and general medical education?”.