Objective:

N/A

Background:

Psychogenic nonepileptic spells (PNES) are episodes that can resemble seizures but are due to underlying psychological stressors rather than abnormal electrical brain activity. Characteristic features of PNES which can help differentiate it from seizures include preserved awareness during the episode, asynchronous movements, thrashing, side-to-side head movements, and pelvic thrusting. PNES can be definitively distinguished from seizures via electroencephalogram (EEG). Antiseizure medications are ineffective in treating PNES, so treatment is aimed at identifying and addressing underlying psychological triggers. While seizures commonly cause neurological complications, PNES is not well-known to cause adverse neurological sequela. We aim to describe the case of a 25-year-od woman who developed bilateral vertebral artery dissections resulting in bilateral cerebellar infarctions after prolonged and abrupt neck flexion repetitive during a PNES episode.  

Design/Methods:

Case report and review of literature.  

Results:

24-year-old woman with an extensive psychiatric history including major depressive disorder, generalized anxiety disorder, panic disorder, and post-traumatic stress disorder was admitted for active suicidal ideation. While admitted, she developed seizure-like activity manifesting in part with prolonged and abrupt neck flexion. A continuous EEG showed no electrographic correlation with her episodes, thus indicating PNES. As part of her seizure-like activity workup, she underwent an MRI brain which showed small acute punctate infarcts in the bilateral cerebellar hemispheres. A CTA of the head and neck showed bilateral vertebral artery dissections seen around the level of C6 with short segment occlusion on the right. Her NIHSS was 0, with her only symptom being difficulty with tandem gait. She was managed with antiplatelets and she did not have further complications  

Conclusions:

Psychogenic nonepileptic spells (PNES) are non-neurological in nature but can still result in neurological complications from unintentional self-injury. Even after definitive diagnosis of PNES, it remains important to assess for neurological injury, treat accordingly, and prevent future recurrence.