Akademik Veri Yönetim Sistemi
27. ulusal çocuk ve ergen ruh sağlığı ve hastalıkları kongresi, İzmir, Türkiye, 10 - 13 Mayıs 2017, ss.279-280
PB118/ A Puzzling Case with Cadasil Syndrome and Conversion Disorder Comorbidity
Esen Yıldırım Demirdöğen, İbrahim Selçuk Esin, Onur Burak Dursun
Department of Child and Adolescent Psychiatry, Faculty of Medicine, Ataturk University,
Erzurum/Turkey
Introduction: Conversion disorder (CD) is a condition of neurological symptoms without
organic cause. Although the etiology of disorder is not fully understood, it is thought that
causes including psychological stress, intrafamilial conflict, childhood trauma, low
socioeconomic status, and the social environment problems may play a role in the emergence of
the disease.
Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and
Leukoencephalopathy (CADASIL) is an autosomal dominant arteriopathy caused by mutations
in the NOTCH3 gene. The clinical manifestations of CADASIL range from single or multiple
lacunar infarcts, transient ischemic attacks, dementia, migraine with aura to psychiatric
disorders.
In our current report we aimed to present a case with conversion disorders and his long
and complex differential diagnosis process.
Case: A 15-year-old boy was admitted to child neurology clinic with the complaints of
headache, difficulty in walking due to having weakness of lower limbs. His neurological
examination was normal. In the brain MR an image that consistent with lacunar infarction was
detected. The patient was hospitalized for differential diagnosis but no neurological pathology
was found to explain the clinic. Then he was consulted to our clinic from child neurology clinic
for evaluation in terms of conversion disorder. In our psychiatric evaluation, the patient was
diagnosed as having conversion disorder and major depressive disorder. After our psychiatric
assessment, although the clinic of the patient spontaneously recovered in a couple of days, a
blood sample was sent to genetic department.for excluding Cadasil Syndrome (for assessing
NOTCH3 gene mutation), During the follow-up period, the family applied to many different
centers for identification of organic reasons but did not continue psychiatric follow-up and the
patient’s complaints repeated again and again. Six months later, when they applied to our clinic
again, he had same symptoms. In the genetic examination, heterozygous notch 3 gene
mutation had been detected but his symptoms could not be explained by Cadasil Syndrome
but by CD. Discussion: In the majority of cases with CD early diagnoses can be achieved by detailed
physical examination and the identification of incongruities. But this is not always so easy,
especially when the organic research is not completed and the family does not believe in
the psychiatric diagnosis. Whereas early recognition of the disorder will limit unnecessary
tests and medications. It should be considered that even in the case of syndromes with
intense organic components, the clinical picture may be due to psychological diagnosis such as
conversion.