[Separation/Conversion Disorders in Functional Coma With Pseudocataplexy: Report of One Case and Literature Review]

Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2024 Aug;46(4):625-629. doi: 10.3881/j.issn.1000-503X.15868.
[Article in Chinese]

Abstract

Separation/conversion disorders in functional coma with pseudocataplexy are rare.On December 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 magnetic 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 electroencephalogram leads and the increased muscular tone in the mandibular electromyography indicated a period of wakefulness.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 environment 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 pseudocataplexy.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 coma and episodic sleep disorders.

功能性昏迷伴假性猝倒发作的分离/转换障碍病例罕见。2021年12月9日山东第一医科大学第一附属医院神经内科收治1例分离/转换障碍青年女性患者,主要表现为发作性意识障碍、猝倒、小便失禁。完善实验室检查及颅脑MRI未见明显异常,行标准多导睡眠监测及多次睡眠潜伏期试验,患者小睡间期无法唤醒,行刺激试验,对压眶、大声呼叫、拍打无反应,但头部导联均为α节律,下颌肌电示肌张力增高,提示为清醒期。行24 h睡眠监测,患者夜间睡眠充足,早晨唤醒容易。行日间无限制睡眠及唤醒试验,患者上午及下午各小睡1次,在导联提示N3期进入N2期睡眠时对患者进行唤醒试验,此时患者可对周围环境进行反应并正确回答问题。检测脑脊液食欲素水平>110 pg/mL,可排除发作性睡病,考虑为伴假性猝倒发作的功能性昏迷。给予口服药物症状改善不明显,建议停口服药并调整作息、情绪,半年后随访,患者诉自行调整生活方式后未再发作,至今3年多次随访均未再出现类似症状。合并有猝倒样发作的功能性昏迷易误诊,需与真性昏迷及发作性睡病相鉴别。.

Keywords: central hypersomnia; functional coma; pseudocataplexy; separation disorder; sleep monitoring.

Publication types

  • Case Reports
  • Review
  • English Abstract

MeSH terms

  • Cataplexy / complications
  • Cataplexy / diagnosis
  • Coma* / etiology
  • Conversion Disorder / complications
  • Conversion Disorder / diagnosis
  • Electroencephalography
  • Female
  • Humans
  • Orexins / cerebrospinal fluid

Substances

  • Orexins