From Software to Hardware: A Case Series of Functional Neurological Symptoms and Cerebrovascular Disease

• Published in: The journal of neuropsychiatry and clinical neurosciences Vol. 36; no. 3; pp. 206 - 213
• Main Authors: Coebergh, Jan, Habib, Shabana, Teodoro, Tiago, Edwards, Mark, Butler, Matt
• Format: Journal Article
• Language: English
• Published: United States 01.07.2024
• Subjects: Functional Symptoms; Cerebrovascular Disease; Stroke; Structure-Function Relationship; Hoover’s Sign; Functional Neurological Disorder
• ISSN: 0895-0172; 1545-7222; 1545-7222
• DOI: 10.1176/appi.neuropsych.20220182

Neuroimaging studies have identified alterations in both brain structure and functional connectivity in patients with functional neurological disorder (FND). For many patients, FND emerges from physical precipitating events. Nevertheless, there are a limited number of case series in the literature that describe the clinical presentation and neuroimaging correlates of FND following cerebrovascular disease. The authors collected data from two clinics in the United Kingdom on 14 cases of acute, improving, or delayed functional neurological symptoms following cerebrovascular events. Most patients had functional neurological symptoms that were localized to cerebrovascular lesions, and the lesions mapped onto regions known to be part of functional networks disrupted in FND, including the thalamus, anterior cingulate gyrus, insula, and temporoparietal junction. The findings demonstrate that structural lesions can lead to FND symptoms, possibly explained through changes in relevant mechanistic functional networks.