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Orthop Traumatol Surg Res. 2015 Sep;101(5):637-41. doi: 10.1016/j.otsr.2015.06.001. Epub 2015 Jul 17.

Conversion paralysis after cervical spine arthroplasty: a case report and literature review.

Author information

1
Unité rachidienne, département de chirurgie orthopédique, hôpital universitaire de Bordeaux, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France. Electronic address: mboudissa@chu-grenoble.fr.
2
Unité rachidienne, département de chirurgie orthopédique, hôpital universitaire de Bordeaux, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France.

Abstract

We report a case of conversion paralysis after cervical spine arthroplasty performed in a 45-year-old woman to treat cervico-brachial neuralgia due to a left-sided C6-C7 disc herniation. Upon awakening from the anaesthesia, she had left hemiplegia sparing the face, with normal sensory function. Magnetic resonance imaging (MRI) of the brain ruled out a stroke. MRI of the spinal cord showed artefacts from the cobalt-chrome prosthesis that precluded confident elimination of mechanical spinal cord compression. Surgery performed on the same day to substitute a cage for the prosthesis ruled out spinal cord compression, while eliminating the source of MRI artefacts. Findings were normal from follow-up MRI scans 1 and 15days later, as well as from neurophysiological testing (electromyogram and motor evoked potentials). The deficit resolved fully within the next 4days. A psychological assessment revealed emotional distress related to an ongoing divorce. The most likely diagnosis was conversion paralysis. Surgeons should be aware that conversion disorder might develop after a procedure on the spine, although the risk of litigation requires re-operation. Familiarity with specific MRI sequences that minimise artefacts can be valuable. A preoperative psychological assessment might improve the detection of patients at high risk for conversion disorder.

KEYWORDS:

Cervical spine prosthesis; Conversion motor disorder; Conversion paralysis; Hysterical paralysis; MRI artefacts

PMID:
26194210
DOI:
10.1016/j.otsr.2015.06.001
[Indexed for MEDLINE]
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