title: Conversion paralysis after cervical spine arthroplasty: a case report and literature review.
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.
authors.affiliation: 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.
authors.forename: M
authors.initials: M
authors.lastname: Boudissa
authors.affiliation: Unité rachidienne, département de chirurgie orthopédique, hôpital universitaire de Bordeaux, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France.
authors.forename: J E
authors.initials: JE
authors.lastname: Castelain
authors.affiliation: Unité rachidienne, département de chirurgie orthopédique, hôpital universitaire de Bordeaux, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France.
authors.forename: L
authors.initials: L
authors.lastname: Boissière
authors.affiliation: Unité rachidienne, département de chirurgie orthopédique, hôpital universitaire de Bordeaux, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France.
authors.forename: R
authors.initials: R
authors.lastname: Mariey
authors.affiliation: Unité rachidienne, département de chirurgie orthopédique, hôpital universitaire de Bordeaux, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France.
authors.forename: V
authors.initials: V
authors.lastname: Pointillart
authors.affiliation: Unité rachidienne, département de chirurgie orthopédique, hôpital universitaire de Bordeaux, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France.
authors.forename: J M
authors.initials: JM
authors.lastname: Vital
mesh_terms: D001178:Arthroplasty; D002574:Cervical Vertebrae / Q000601:surgery*; D003291:Conversion Disorder / Q000523:psychology*; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000601:surgery; D008875:Middle Aged; D010243:Paralysis / Q000523:psychology*; D011183:Postoperative Complications; D013315:Stress, Psychological / Q000150:complications
keywords: Cervical spine prosthesis; Conversion motor disorder; Conversion paralysis; Hysterical paralysis; MRI artefacts