Separation/Conversion Disorders in Functional Coma With Pseudocataplexy:Report of One Case and Literature Review
10.3881/j.issn.1000-503X.15868
- VernacularTitle:功能性昏迷伴假性猝倒发作的分离/转换障碍一例并文献复习
- Author:
Wanyu ZHAO
1
;
Baokun ZHANG
;
Xiao ZHANG
;
Xiaoyu ZHANG
;
Xiaomin LIU
;
Jiyou TANG
Author Information
1. 山东第一医科大学第一附属医院神经内科,济南 250000
- Keywords:
functional coma;
pseudocataplexy;
separation disorder;
central hypersomnia;
sleep monitoring
- From:
Acta Academiae Medicinae Sinicae
2024;46(4):625-629
- CountryChina
- Language:Chinese
-
Abstract:
Separation/conversion disorders in functional coma with pseudocataplexy are rare.On De-cember 9,2021,a young female patient with separation/conversion disorders was treated in the Department of Neurology in the First Affiliated Hospital of Shandong First Medical University.The main symptoms were episodic consciousness disorders,sudden fainting,and urinary incontinence.Complete laboratory tests and cranial mag-netic resonance imaging showed no obvious abnormalities.Standard multi-channel sleep monitoring and multiple sleep latency tests were performed.The patient was unable to wake up during nap and underwent stimulation tests.There was no response to orbital pressure,loud calls,or tapping,while the α rhythm in all electroenceph-alogram leads and the increased muscular tone in the mandibular electromyography indicated a period of wakeful-ness.The results of 24-hour sleep monitoring suggested that the patient had sufficient sleep at night and thus was easy to wake up in the morning.The results of daytime unrestricted sleep and wake-up test showed that the patient took one nap in the morning and one nap in the afternoon.When the lead indicated the transition from N3 to N2 sleep,a wake-up test was performed on the patient.At this time,the patient reacted to the surrounding environ-ment and answered questions correctly.Because the level of orexin in the cerebrospinal fluid was over 110 pg/mL,episodic sleep disorder was excluded and the case was diagnosed as functional coma accompanied by pseudocata-plexy.The patient did not present obvious symptom remission after taking oral medication,and thus medication withdrawl was recommended.Meanwhile,the patient was introduced to adjust the daily routine and mood.The follow-up was conducted six months later,and the patient reported that she did not experience similar symptoms after adjusting lifestyle.Up to now,no similar symptoms have appeared in multiple follow-up visits for three years.Functional coma with pseudocataplexy is prone to misdiagnosis and needs to be distinguished from true co-ma and episodic sleep disorders.
