A fifteen-year journey to total physical disability; A case of Astasia-abasia.

<p><strong>Introduction </strong></p> <p>The diagnosis of functional movement disorders including Astasia-abasia is always a challenge even with seasoned clinicians due to a tendency to border on caution to avoid missing potentially life threatening structural neurological disorders leading to delays in diagnosis. Chronicity of symptoms, a guarded prognosis and eventual physical conditioning pose treatment challenges.</p> <p><strong>Case presentation </strong></p> <p>We present a case of a 69-year-old Caucasian man with past medical history of essential hypertension, well controlled type II diabetes mellitus, hyperlipidemia and generalized anxiety disorder who was evaluated in three hospital systems for what he described as ‘difficulty standing in one position’ and later gait disturbances that was incongruent with findings on neurological examination and well as imaging, nerve conduction studies and electromyography. We describe his clinical course to becoming wheelchair bound eventually having multiple hospital admissions due to life threatening complications of immobility including decubitus ulcers, sepsis and rhabdomyolysis leading to acute kidney injury.</p> <p><strong>Discussion </strong></p> <p>The presented case of Astasia-abasia highlights diagnostic challenges involving repetition of diagnostic tests as patients move from one hospital system to another, as well as unpredictability of treatment response and the potential for severe physical deconditioning leading to medical complications of immobility.</p>