Post-operative functional neurological symptom disorder after anesthesia

Emergence and recovery during the immediate post-anesthetic recovery period is a vulnerable and unpredictable stage for every patient. A rare manifestation during this period may include the occurrence of functional neurological symptom disorder (FNSD).

FNSD is described as neurological symptoms that are not consistently explained by neurological or medical conditions. A high suspicion should be given to this diagnosis after excluding life-threatening causes and when physical exam signs are inconsistent with an organic cause.

The group of researchers from the Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA described the largest case series-to-date consisting of six patients who developed FNSD in the immediate post-anesthetic period. Additionally, they performed a systematic review of the literature to identify published reports of post-anesthetic FNSD in their paper published in BJBMS.

These data may help inform the anesthesia literature on presentation, risk factors, management, and treatment outcomes of post-operative FNSD in the context of anesthetic administration, and may also facilitate the stratification of patients who are at high-risk for experiencing these spells.

Potential risk factors of FNSD include female sex, history of prior FNSD spell, psychiatric illness, and general anesthesia. While no deaths were experienced in patients experiencing post-anesthetic FNSD, many had unanticipated admission to the hospital (53%) or to the intensive care unit (25%).

Prompt diagnosis and management of this condition may prevent unnecessary diagnostic studies, invasive procedures and their associated potential complications, and hospital cost.

Reference:

D’Souza RS, Vogt MN, Rho EH. Post-operative functional neurological symptom disorder after anesthesia. Bosn J of Basic Med Sci. 2020

Editor: Edna Skopljak