Hemorrhage Accompanying Psychogenic Nonepileptic Seizure During Cesarean Section: A Case Report

Yunxi Lu,1,* Wanshun Liu,2,* Yihui Yang1 1Department of Anesthesia, The Third Affiliated Hospital of Zunyi Medical University (The First People’s Hospital of Zunyi), Zunyi, Guizhou, People’s Republic of China; 2Department of Orthopaedic Surgery, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, People’s Republic of China*These authors contributed equally to this workCorrespondence: Yihui Yang, Department of Anesthesia, The Third Affiliated Hospital of Zunyi Medical University (The First People’s Hospital of Zunyi), Zunyi, Guizhou, People’s Republic of China, Email [email protected]: Psychogenic nonepileptic seizures (PNES) during the perioperative period remain an underrecognized and under-investigated phenomenon. This type of disorder is characterized by sudden and short-lived convulsions, but they are which triggered by psychological factors. In cases of lack of experience, PNES is prone to be identified as epilepsy. Correct identification and proper treatment can more effectively protect patient safety.Patient Concerns: A pregnant woman, with a history of two miscarriages, developed unexplained convulsions after gynecologic surgery two years ago. The current plan is to perform a cesarean section under subarachnoid anesthesia. One hour after the fetus was delivered smoothly, when she was about to be transferred to the ward, a large amount of vaginal bleeding was found. The patient was reoperated on to control the bleeding immediately, during reoperation, she got a series of convulsions, charactered by involuntary head swaying and involuntary twitching of both upper limbs. The patient remained conscious and no symptoms such as staring with both eyes or foaming at the mouth were observed.Main Diagnoses, Interventions, and Outcomes: After the convulsions occurred, the patient was subjected to general anesthesia with tracheal intubation. After the operation, the patient was transferred to the intensive care unit for observation. Based on the patient’s clinical manifestations and past medical history, the final diagnosis was PNES. On the fifth day after the operation, the patient was discharged safely.Conclusion: PNES are an important differential diagnosis for perioperative convulsive seizures. Patients often suffer from anxiety, depression or other mental disorders or stress. During an attack, it is often manifested as involuntary left and right swaying of the head and upper limbs, without loss of consciousness.Keywords: psychogenic nonepileptic seizure, PNES, convulsion, postpartum hemorrhage, cesarean section, differential diagnosis, case report