Postpartum Conversion Disorder after Vaginal Delivery Under Epidural Analgesia

Conversion disorder or functional neurologic symptom disorder is a diagnosis of exclusion in situations which the patients' symptoms and clinical findings(signs) are not consistent with a wellestablished organic reason and is not fully justifiable to make the diagnosis. Conversion disorder can present by very diverse manifestations such as: Aphonia, Motor and sensory loss, Ataxia, Psudoseizure, Dystonia, myoclonus, etc. almost always there is a psychologic trigger for conversion and in fact conversion or somatization is a way of dealing with stress for the human body. On one hand childbirth is a stressor of great magnitude and can act as a trigger for conversion disorder and on the other hand neurologic symptoms may being referred to anesthesia side effects (regional, neuraxial and general) and mislead the true diagnosis and appropriate treatment.

A 33 years old woman gave birth to a healthy and vigorous newborn by vaginal delivery under epidural analgesia. immediately after entering to the recovery unit the mother presented aphonia and motor function loss of the limbs while being conscious and oriented. The mother was not agitated due to her symptom and could fully understand conversations and answer our questions with head movements. Her symptoms went away within 2 hours of being under observe in the recovery unit and she got fully recovered and symptom free. After thorough assessment of the patient we were led to the diagnosis of conversion disorder which was proven correct after neurologic and psychiatric consultations.

Although conversion disorder is diagnosed after having other possible diagnoses ruled out, it is important to consider conversion disorder as a possible diagnosis when we are facing neurologic symptoms inconsistent with clinical findings, especially in young women after a psychologic stressful situation like childbirth. considering the obstetric patients’ properties, we expect obstetric anesthesiologists to visit greater number of conversion patients in the perioperative time in comparison with other anesthesia fields.