Patients with non-organic or functional disorders do indeed present frequently to stroke services. The hazard for the patient is that they may receive IV thrombolysis – although limited available data.1
Chen et al 2 suggests as the authors here observe, that patients presenting with non-organic or functional disorders are at a relatively low risk of significant harm as a result of IV thombolysis.
The other risk for patients presenting with conversion disorders or associated non-organic symptoms is that they may be subject to inappropriate investigations. However, since the consequences of missing a stroke diagnosis may be non-trivial and the diagnosis of a conversion disorder is almost always made retrospectively, it is very hard to avoid a degree of investigation that may confer harm upon the patient (whether in terms of exposure to ionizing radiation, contrast media, or discovery of incidental abnormalities).
Use of the MDT can be very helpful in identifying as well as treating these patients. They respond well to occupational therapy and physiotherapy input.
It is worth spending some time with the patient to explain that they have not had a stroke and that the cause of the symptoms may not be physiological.
Dr James Scott MRCP MSc
Consultant Stroke Physician
1. Winkler DT, Fluri F, Fuhr P, et al. Thrombolysis in stroke mimics: frequency, clinical characteristics, and outcome. Stroke 2009;40:1522–5.
2. Chen Y, Bogosavljevic V, Leys D, et al. Intravenous thrombolytic therapy in patients with stroke mimics: baseline characteristics and safety profile. Eur J Neurol 2011;18:1246–50.
Stroke mimic: an interesting case of repetitive conversion disorder