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Clinical and Research Reports
Published Online: 12 February 2024

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

Jan Coebergh, M.B.B.S., F.R.C.P. [email protected], Shabana Habib, M.B.B.S., Tiago Teodoro, M.B.B.S., Ph.D., Mark Edwards, M.B.B.S., Ph.D., and Matt Butler, M.B.B.S.Authors Info & Affiliations
Publication: The Journal of Neuropsychiatry and Clinical Neurosciences
Volume 36, Number 3
https://doi.org/10.1176/appi.neuropsych.20220182
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Abstract

Objective:

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.

Methods:

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.

Results:

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.

Conclusions:

The findings demonstrate that structural lesions can lead to FND symptoms, possibly explained through changes in relevant mechanistic functional networks.

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Supplementary Material

File (appi.neuropsych.20220182.ds001.pdf)

Information & Authors

Information

Published In

Go to The Journal of Neuropsychiatry and Clinical Neurosciences
Go to The Journal of Neuropsychiatry and Clinical Neurosciences
The Journal of Neuropsychiatry and Clinical Neurosciences
Volume 36 • Number 3 • Summer 2024
Pages: 206 - 213
PubMed: 38343312

History

Received: 14 October 2022
Revision received: 25 February 2023
Revision received: 7 May 2023
Revision received: 4 July 2023
Revision received: 18 September 2023
Accepted: 19 October 2023
Published online: 12 February 2024
Published in print: Summer 2024

Keywords

  1. Cerebrovascular Disease
  2. Hoover’s Sign
  3. Functional Neurological Disorder
  4. Functional Symptoms
  5. Stroke
  6. Structure-Function Relationship

Authors

Affiliations

Jan Coebergh, M.B.B.S., F.R.C.P. [email protected]
St. George’s University Hospitals National Health Service Foundation Trust, London (Coebergh, Teodoro); Department of Neurology, Ashford and St. Peter’s Hospitals National Health Service Foundation Trust, Chertsey, United Kingdom (Coebergh, Teodoro); St. John’s Institute of Dermatology, London (Habib); Institute of Psychiatry, Psychology, and Neuroscience, King’s College London (Edwards, Butler).
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Shabana Habib, M.B.B.S.
St. George’s University Hospitals National Health Service Foundation Trust, London (Coebergh, Teodoro); Department of Neurology, Ashford and St. Peter’s Hospitals National Health Service Foundation Trust, Chertsey, United Kingdom (Coebergh, Teodoro); St. John’s Institute of Dermatology, London (Habib); Institute of Psychiatry, Psychology, and Neuroscience, King’s College London (Edwards, Butler).
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Tiago Teodoro, M.B.B.S., Ph.D.
St. George’s University Hospitals National Health Service Foundation Trust, London (Coebergh, Teodoro); Department of Neurology, Ashford and St. Peter’s Hospitals National Health Service Foundation Trust, Chertsey, United Kingdom (Coebergh, Teodoro); St. John’s Institute of Dermatology, London (Habib); Institute of Psychiatry, Psychology, and Neuroscience, King’s College London (Edwards, Butler).
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Mark Edwards, M.B.B.S., Ph.D.
St. George’s University Hospitals National Health Service Foundation Trust, London (Coebergh, Teodoro); Department of Neurology, Ashford and St. Peter’s Hospitals National Health Service Foundation Trust, Chertsey, United Kingdom (Coebergh, Teodoro); St. John’s Institute of Dermatology, London (Habib); Institute of Psychiatry, Psychology, and Neuroscience, King’s College London (Edwards, Butler).
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Matt Butler, M.B.B.S.
St. George’s University Hospitals National Health Service Foundation Trust, London (Coebergh, Teodoro); Department of Neurology, Ashford and St. Peter’s Hospitals National Health Service Foundation Trust, Chertsey, United Kingdom (Coebergh, Teodoro); St. John’s Institute of Dermatology, London (Habib); Institute of Psychiatry, Psychology, and Neuroscience, King’s College London (Edwards, Butler).
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Notes

Send correspondence to Dr. Coebergh ([email protected]).

Competing Interests

Dr. Coebergh has received remuneration from Bial, Brittania, and Janssen for educational events. Dr. Edwards provides medical expert reporting in personal injury and clinical negligence cases; he owns shares in Brain and Mind and has received financial support for lectures from the International Parkinson’s and Movement Disorders Society and the Functional Neurological Disorder Society (FNDS), royalties from Oxford University Press, and honoraria for medical advice to Teva Pharmaceuticals; and he is an associate editor of the European Journal of Neurology, a member of the international executive committee of the International Parkinson’s and Movement Disorders Society, a board member of the FNDS, and a medical advisory board member of the FND Hope UK and Dystonia UK charities. The other authors report no financial relationships with commercial interests.

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