When Functional Neurological Symptom Disorder Isn't Functional: A Case Report of Basal Ganglia Infarct Mimicking Psychiatric Illness

Functional neurological symptom disorder, also known as “conversion disorder,” is a common source of disability in medicine. Patients have often been misdiagnosed, correctly diagnosed after lengthy delays, and/or subjected to poorly delivered diagnoses that prevent diagnostic understanding and lead to inappropriate treatments, iatrogenic harm, unnecessary and costly evaluations, and poor outcomes.A 45-year-old female presented with sudden onset muteness, generalized weakness, and excessive daytime somnolence, initially suggesting a diagnosis of conversion disorder. However, an MRI scan revealed an acute infarct in the right basal ganglia and a small infarct in the left gangliocapsular region, indicating a vascular infarct as the underlying cause. This case highlights the importance of considering neurological examination in patients presenting with unusual symptoms, duration, and treatment response, to avoid misdiagnosis and provide accurate treatment. It also emphasizes the complex interplay between psychological and neurological factors in patients presenting with unusual symptoms.