J Med Cases

Journal of Medical Cases, ISSN 1923-4155 print, 1923-4163 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Med Cases and Elmer Press Inc

Journal website http://www.journalmc.org

Case Report

Volume 8, Number 10, October 2017, pages 326-329

Diagnosis and Management of Postoperative Conversion Disorder in an Adolescent Following Arthroscopic Meniscectomy

**Table 1.** Reports of Postoperative Conversion Disorders in Children
Author and reference	Patient demographics	Brief summary
CD: conversion disorder; ED: emergency department; PACU: post-anesthesia care unit; EGD: esophagogastroduodenoscopy; EUS: endoscopic ultrasound; ENT: ear, nose, and throat.
Haden [6]	A 12-year-old girl with tongue paralysis after dental surgery	Postoperatively, the patient stated she was unable to move her tongue and hypoglossal nerve injury was suspected. The tongue had fasciculations and small movement was noted. MRI was normal. A diagnosis of CD was made. She was evaluated by a family therapist and pediatric counselor. She remained in the hospital for 5 days and gradually improved.
Reilly et al [7]	An 11-year-old with torticollis and neck pain after tonsillectomy	On postoperative day 25, the patient presented to the ED with torticollis and trismus following an uncomplicated tonsillectomy. No identifiable etiology for torticollis was identified as laboratory studies and radiographic images were normal. After discussion with the family, it was determined that the torticollis was intermittent, often associated with anxiety with medical intervention, and absent during sleep. After a 4-day hospitalization, CD was diagnosed. At 6-week follow-up, the patient’s torticollis had resolved completely.
Judge and Spielman [8]	A 16-year-old girl for Gelfoam^® injection for left vocal cord paralysis	Following the procedure, the patient developed left-sided weakness involving her face as well as all her extremities. Attempts at phonation were weak. A neurology consultation was obtained. Electrolytes and imaging (CT, MRI) were normal. Psychological evaluation was performed on postoperative day 3 and revealed anxiety and emotional distress with significant family life stresses. On postoperative day 8, she was discharged with follow-up appointments for physical and psychiatric therapy. During recovery, she required the use of ambulatory assist devices for 3 months but was then able to resume her normal social activities.
Ryu et al [9]	A 13-year-old girl with lower extremity paralysis after laparoscopic appendectomy	On postoperative day 2, the patient presented with hypoesthesia and weakness in the right lower extremity. She was unable to sense light touch between the T11 and L2 dermatome. Her motor strength of right hip and knee were reduced to 2/5. Pelvic and lumbar MRI were normal. The paralysis persisted for 10 days. On postoperative day 13, nerve conduction study was normal. She underwent rehabilitation training twice daily with a physical therapy. On postoperative day 22, she was able to independently walk. On postoperative day 23, a CD was diagnosed. At 1 month follow-up, the patient improved gradually and returned to normal life activities.
Nelson and Wu [10]	A 13-year-old girl for upper endoscopy	Patient had an acute onset of inspiratory stridor and unresponsiveness to verbal stimuli in the PACU. Later during the postoperative course, she developed sensory loss and the acute onset of right-sided hemiplegia. Extensive workup including ENT consultation and MRI failed to reveal any organic cause for the problem. Postoperatively, the patient’s stridor and mental status gradually returned to baseline.

Table 1. Reports of Postoperative Conversion Disorders in Children

Author and reference

Patient demographics

Brief summary

CD: conversion disorder; ED: emergency department; PACU: post-anesthesia care unit; EGD: esophagogastroduodenoscopy; EUS: endoscopic ultrasound; ENT: ear, nose, and throat.

Haden [6]

A 12-year-old girl with tongue paralysis after dental surgery

Postoperatively, the patient stated she was unable to move her tongue and hypoglossal nerve injury was suspected. The tongue had fasciculations and small movement was noted. MRI was normal. A diagnosis of CD was made. She was evaluated by a family therapist and pediatric counselor. She remained in the hospital for 5 days and gradually improved.

Reilly et al [7]

An 11-year-old with torticollis and neck pain after tonsillectomy

On postoperative day 25, the patient presented to the ED with torticollis and trismus following an uncomplicated tonsillectomy. No identifiable etiology for torticollis was identified as laboratory studies and radiographic images were normal. After discussion with the family, it was determined that the torticollis was intermittent, often associated with anxiety with medical intervention, and absent during sleep. After a 4-day hospitalization, CD was diagnosed. At 6-week follow-up, the patient’s torticollis had resolved completely.

Judge and Spielman [8]

A 16-year-old girl for Gelfoam^® injection for left vocal cord paralysis

Following the procedure, the patient developed left-sided weakness involving her face as well as all her extremities. Attempts at phonation were weak. A neurology consultation was obtained. Electrolytes and imaging (CT, MRI) were normal. Psychological evaluation was performed on postoperative day 3 and revealed anxiety and emotional distress with significant family life stresses. On postoperative day 8, she was discharged with follow-up appointments for physical and psychiatric therapy. During recovery, she required the use of ambulatory assist devices for 3 months but was then able to resume her normal social activities.

Ryu et al [9]

A 13-year-old girl with lower extremity paralysis after laparoscopic appendectomy

On postoperative day 2, the patient presented with hypoesthesia and weakness in the right lower extremity. She was unable to sense light touch between the T11 and L2 dermatome. Her motor strength of right hip and knee were reduced to 2/5. Pelvic and lumbar MRI were normal. The paralysis persisted for 10 days. On postoperative day 13, nerve conduction study was normal. She underwent rehabilitation training twice daily with a physical therapy. On postoperative day 22, she was able to independently walk. On postoperative day 23, a CD was diagnosed. At 1 month follow-up, the patient improved gradually and returned to normal life activities.

Nelson and Wu [10]

A 13-year-old girl for upper endoscopy

Patient had an acute onset of inspiratory stridor and unresponsiveness to verbal stimuli in the PACU. Later during the postoperative course, she developed sensory loss and the acute onset of right-sided hemiplegia. Extensive workup including ENT consultation and MRI failed to reveal any organic cause for the problem. Postoperatively, the patient’s stridor and mental status gradually returned to baseline.